New Client Forms

We are honored that you have chosen Bolton Music Therapy to meet your needs. Please fill out the following paperwork and email it to us prior to your assessment session. Also, please email or bring with you copies of insurance card, driver’s license, IEP/IFSP, diagnostic evaluations, and evaluations/progress reports from other therapies. (We can make copies at our office.)

For Child Clients

Welcome to Bolton Music Therapy Letter

Intake Form

  • Please fill this form out in its entirety and email to
  • Each of the small boxes requires initials to ensure that you read and understand the policies.
  • On the consent forms, you may type “no” if you do not to consent to a particular item.
  • Insurance form should be completed by any families who wish us to seek insurance reimbursement.
  • The last five pages include release forms that give us permission to speak to other professionals about your child. Please fill out separate forms for your child’s school, other therapists (speech, OT, PT, art, dance, ABA, etc.), primary care doctor, and other specialists (neurologist, etc.). If you need more, additional forms are located below.
  • We will print out the pages needing signatures for you to sign at your appointment.

Additional Information Release Forms

HIPAA Notice

For Adult Clients

Coming Soon