New Participant Interest Form
Thank you for your interest in joining the Peer Supervision group for Perinatal Music Therapists (PPMT Supervision). Please complete and submit this interest form and tell us about your experience. Then, watch for an email from
once your form is reviewed. Also, you may reserve your seat with a deposit at
Thank you again for your interest in peer supervision. We look forward to your participation,
Kate & Heidi
Kate Taylor, MA, MTBC
Continuing education director
Creative Childbirth Concepts®
Heidi Lengel, MMT, MTBC
Fulheart Family Support
Please enter your name
Please provide us with your email address.
Please provide us with the location of your practice.
Country, Region or State.
How long have you been practicing as a music therapist?
less than one year
Over 25 years
Please indicate your highest level of degree training in music therapy.
Do you have advanced clinical training in music therapy assisted childbirth (MTACB)?
Are you currently providing music therapy to perinatal populations?
(i.e. couples in fertility tx, pregnant mothers or families, post-partum women and their familes, etc.
If yes, how long have you been practicing specifically with perinatal populations?
less than one year
21 years or more
Please check any area on the perinatal spectrum you have worked with:
Labor and Delivery
If no, when do you anticipate starting to provide perinatal music therapy services?
in the next 3 months
within 6 months
9 months from now
1 year from now
within the next 3 years
within the next 5 years
I do not plan to provide pre and perinatal music therapy services.
Please tell us a little about why you are seeking peer supervision on perinatal music therapy.
Please tell us a little about why are seeking peer supervision on perinatal music therapy.
How did you hear about the perinatal music therapy peer superivison group?
(check all that apply)
Online Conference for Music Therapy (OCMT2015)
Heidi Lengel, MMT, MT-BC
Kate Taylor, MA, MT-BC
Another perinatal music therapist referred me to the group
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