Music Therapy Referral Form

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Thank you for looking in to music therapy. If you complete this form the information will be sent to the Music Services referral team, which will allow them to try and find a suitable session.

If you can't complete this form., you can download the referral form, complete and return to us preferably via email to Otherwise you can call us on 020 7267 4496 to request a paper form.

If you need any help, or cannot com the form yourself, please contact the admin team over the phone (020 7267 4496) to schedule a telephone appointment where assistance can be provided on the allocated date and time of call back option.


Please select all the music therapy centres that you would be able to travel to.