After we have received your referral form, an initial session will be booked where we can discuss your goals, and plan an appropriate course of action.

Referral Form

New Client Referral Form

Thank you for choosing Preston Music Therapy. We’re looking forward to working with you. To help us tailor a therapy plan to your needs, please complete the following information. All details are kept strictly confidential and will never be shared without your consent. If you have any questions, feel free to contact Paul Byrnes at 0410 866 286 or paul@prestonmusictherapy.com.au.

Name

First

Last

Preferred Name

Date of Birth

Address

Phone

Sex & Gender Identity

Parent/carer name

Emergency Contact Name

Emergency Contact Details

NDIS Number

How is your NDIS funding managed?

If your funding is Plan-Managed, what is the name of your Plan Management company and their contact details for invoicing

Please describe some of the challenges and/or diagnoses you/the client lives with.

What is your/the client's favourite thing to do or greatest strengths?

style days Name

Is there any other relevant medical information that we need to be aware of (Seizure plan, sensory sensitivities, particular behavioural strategies etc…)?

Are there any other safety or behavioural concerns that we need to know about?

Do you/the client have a cultural or religious background that you’d like Preston Music Therapy to know about?

Do you/client play any musical instruments? If so, please describe.

Do you/client have a favourite song, style of music, artist or instrument? If so, please provide details.

Do you have a preference for in-person music therapy sessions or Telehealth sessions?

Do you have any preferences for days for music therapy sessions?

Do you have any preferences for times for music therapy sessions?

Will there be another trusted adult in the sessions? If so, whom is this likely to be?

What are your/your clients goals for music therapy?

After we have received your referral form, an initial session will be booked where we can discuss your goals, and plan an appropriate course of action.

Referral Form

Not sure if music therapy fits your NDIS plan?

Accreditations & Media

Preston Music Therapy is a Government certified NDIS provider.

Referral form

Contact Us

+61 410 866 286

paul@prestonmusictherapy.com.au

Connect

AMTA

Facebook

Instagram

YouTube

MUSIC THERAPY IN INNER NORTH MELBOURNE:
PRESTON, RESERVOIR, THORNBURY, NORTHCOTE, FAWKNER, COBURG, BRUNSWICK, IVANHOE, KEW, THOMASTOWN, HEIDELBERG, BUNDOORA, KINGSBURY, MCLOUD, WATSONIA, CARLTON, FITZROY, CLIFTON HILL, COLLINGWOOD, ABBOTSFORD, PARKVILLE.

Preston Music Therapy acknowledges Aboriginal and Torres Strait Islander people as the Traditional Custodians of the land and acknowledges and pays respect to their Elders, past and present.

© 2025. All rights reserved. ABN:46361740027

Made by Ikonik Media

After we have received your referral form, an initial session will be booked where we can discuss your goals, and plan an appropriate course of action.

Referral Form

Not sure if music therapy fits your NDIS plan?

Preston Music Therapy is a Government certified NDIS provider.

Referral form

Contact Us

+61 410 866 286

paul@prestonmusictherapy.com.au

Connect

AMTA

Facebook

Instagram

YouTube

MUSIC THERAPY IN INNER NORTH MELBOURNE: PRESTON, RESERVOIR, THORNBURY, NORTHCOTE, FAWKNER, COBURG, BRUNSWICK, IVANHOE, KEW, THOMASTOWN, HEIDELBERG, BUNDOORA, KINGSBURY, MCLOUD, WATSONIA, CARLTON, FITZROY, CLIFTON HILL, COLLINGWOOD, ABBOTSFORD, PARKVILLE.

Preston Music Therapy acknowledges Aboriginal and Torres Strait Islander people as the Traditional Custodians of the land and acknowledges and pays respect to their Elders, past and present.

© 2025. All rights reserved. ABN:46361740027

Made by Ikonik Media

MUSIC THERAPY IN INNER NORTH MELBOURNE:
PRESTON, RESERVOIR, THORNBURY, NORTHCOTE, FAWKNER, COBURG, BRUNSWICK, IVANHOE, KEW, THOMASTOWN, HEIDELBERG, BUNDOORA, KINGSBURY, MCLOUD, WATSONIA, CARLTON, FITZROY, CLIFTON HILL, COLLINGWOOD, ABBOTSFORD, PARKVILLE.