Art Therapy Referral Form

Newcastle Music Therapy is a registered NDIS service provider.

Newcastle Music Therapy takes privacy seriously and will only collect, hold, use and disclose your personal information in accordance with the Privacy Act. Newcastle Music Therapy’s privacy policy can be found here.

Access to personal information held within Newcastle Music Therapy is restricted to authorised persons who are Newcastle Music Therapy staff or contractors. Electronic and paper records containing personal information are protected in accordance with New South Wales Health security policies.

Newcastle Music Therapy will not ask you for any personal information which we do not need. The Privacy Act requires that we collect information for a purpose that is reasonably necessary for, or directly related to, a function or activity of Newcastle Music Therapy. We are also required to follow the NDIS Code of Conduct as set out in the National Disability Insurance Scheme (Code of Conduct) Rules 2018.

You are under no obligation to answer every question in this referral form. However, some fields do require an answer in order for your referral form to be submitted. If you would prefer to provide these details in another way, please contact us on 0410 834 885 or email

If you have any problems submitting this form, or would prefer to fill out a manual form, click the button below for a PDF version:

Art Therapy Referral Form - all fields marked with * are mandatory


How Is Your NDIS Plan Managed?

Frequency of Sessions*

How is it for you stepping up and down stairs WITH a railing/wall?*

13 + 8 =

 When you hit “Submit” you should be taken to a thank you page – IF THIS DOES NOT HAPPEN please make sure you check that all mandatory fields are filled in.

If you have any problems submitting this form, or would prefer to fill out a manual form, click here for a PDF version.

PDF forms can be submitted by emailing the completed form to

Our Address

16/363 Hillsborough Road
Warners Bay NSW 2282