Online consultation form (No fee) Name(required) Email(required) Phone(required) Occupation(required) Address with country and pin code(required) Year of Birth(required) Your Government issued Photo ID number (Aadhar No, Social Security No etc) that will demand to show during treatment(required) Are you(required) Indian Foreigner Sex(required) Male Female Don't want to disclose Marital Status(required) Married Unmarried Divorced Don't want to disclose Family type(required) Joint Family Nuclear Family If female, Are you pregnant? Yes No If "yes", how many weeks? Please give expected date of delivery. Height (in Cm)(required) Weight (in Kg)(required) Normal diet pattern(required) Vegetarian Non-Vegetarian Mix Dependence On?(required) Alcohol Drugs Smoking Coffee/Tea Medicine Not Applicable Online games Online social sites Facebook, WhatsApp etc Have any of your dependent's ever received any form of physiotherapy, occupational therapy or chiropractic treatment?(required) Yes No If Yes, Please describe in brief. Are you listing music daily(required) Yes No If Yes –How many hours per day Which type of music you like tom listen(required) Folk Classical Filmy Religious Western Indian Instrumental Other Status of sound volume you use(required) High Low Write your 5-10 favorite Songs, Gazals etc which you are listening commonly with the name of their album or film(required) What you expected from music therapy(required) What are the medicines you are taking at present?(required) Describe the intensity of the problem? When does the intensity decrease by its own accord? Which factors do you feel trigger it?(required) What types of treatments and medicines have you taken so far? What have been the results? Have you observed any side effects?(required) Are you ready to share your medical, pathological reports, if required(required) Yes No Are you want to participate in online workshop conducted on Music therapy(required) Yes No Submit, We will contact you Δ Share this:TwitterFacebookLike this:Like Loading...
Indian Association of Music Therapy