Music Therapy Social Groups
How old is the participant?
What are the main skill areas the participant is working on?
Communication (verbal and nonverbal)
Speech and language
Emotional skills (regulation)
Confidence and Self-Expression
Pre-academic skills (counting, colours, body parts, shapes)
Cognitive skills (patterns, critical thinking, problem solving, decision making)
What is the participant's diagnosis?
Autism Spectrum Disorder
Behaviour Disorder (ODD or a Conduct Disorder)
Fetal Alcohol Syndrome
Fragile X Syndrome
Sensory Processing Disorder
How would you rate the participant's disability/disorder?
What area of the city would the participant be willing to travel to?
What days and times of the week work best?
Monday morning (9-12)
Monday afternoon (12-3)
Monday evening (4-8)
Tuesday morning (9-12)
Tuesday afternoon (12-3)
Tuesday evening (4-8)
Wednesday morning (9-12)
Wednesday afternoon (12-3)
Wednesday evening (4-8)
Thursday morning (9-12)
Thursday afternoon (12-3)
Thursday evening (4-8)
Friday morning (9-12)
Friday afternoon afternoon (12-3)
Friday evening (4-8)
Does the participant use a wheelchair?
If this is something that appeals to you, please leave your email address so you can be contacted if there is enough interest in these sessions.
Never submit passwords through Google Forms.
This form was created inside of Canary Music Therapy.