Music Therapy Interest Form
Please fill out the following form to your best ability. At Middlesex Music Academy, we prioritize your safety, privacy, and well-being. Our therapist adheres to the highest ethical standards and maintains strict confidentiality. We create a safe and supportive environment where you can explore your emotions and express yourself freely through music.
Terms and Disclaimers
- Commitment: Please note that to be successful in Music Therapy it is required that you attend all scheduled sessions. If you have to miss a session, you must notify the therapist and reschedule to attend within the same week. Inability to do so within 24 hours before the session will result in a "No-Show” in which you will be billed the full session amount. No exceptions.
- Liability Clause: I acknowledge that participation in Music Therapy sessions may involve physical, emotional, and social activities that carry some risk. I assume full responsibility for any risk or injury associated with participation in these sessions. I release and hold harmless the organizers, therapists, and facilitators of this program from any and all claims or liability arising from my participation.
- Privacy of Information: All information provided in this form is confidential and will be used solely to assess eligibility and tailor therapy sessions to meet the participant’s needs. We respect your privacy, and your information will not be shared outside of this program without explicit consent, except where required by law.
- Documentation and Assessment Access: During Music Therapy Sessions, assessments and session notes may be recorded to document progress and inform future sessions. Participants, or their legal guardians if applicable, have the right to review these records upon request. To request access, please contact the program facilitator. We aim to provide transparent and supportive care by allowing participants insight into their therapeutic progress.