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Cmtw Remote Music Therapy Services Agreement

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CMTW Remote Music Therapy Services Agreement

Therapy Session Consent Agreement for Teletherapy

Page 1

Please complete the following questions to participate in remote music therapy services.

Email*

First Name*

Last Name*

Date of Birth*

Select date

Gender*

Race/Ethnicity*

Address*

City*

State*

10.

Zip Code*

11.

Phone Number*

12.

Emergency Contact Name*

13.

Emergency Contact Phone Number*

Description:CMTW Remote Music Therapy Services Agreement

This Therapy Session Consent Agreement for Teletherapy outlines the terms and conditions of remote music therapy services provided by CMTW. By signing this agreement, clients consent to participate in teletherapy sessions and agree to the terms and conditions outlined in the agreement. The agreement covers important topics such as confidentiality, informed consent, and the use of technology in remote therapy sessions. CMTW is committed to providing high-quality remote music therapy services that meet the needs of clients in a safe and secure manner.

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What is the date of the assessment?*

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