RGV Music Therapy and Wellness Center

RGV Music Therapy and Wellness Center Send Message

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

State

Select the state you live in

Location

Help us connect you with a therapist in your preferred area.

Brownsville Harlingen/San Benito Mid-Valley Pharr/San Juan/Alamo McAllen/Mission/Edinburg Starr County Laredo

Reason for care

What is the reason for seeking care?

Mental health Developmental health Social support Community integration Support in hospice or end-of-life care Wellness Cognitive health Communication skills Behavioral support Neurologic health Other

What kind of care is being sought?

Music therapy Recreational therapy Behavioral support Community wellness Other

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

Administrative

Inquiry reason

Client Preferences

Preferred appointment times

Morning Afternoon Evening Weekend

Preferred clinician

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Preferred modality

Is there anything that the practitioner needs to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

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Billing & Payment

Reimbursement Eligibility

Are you eligible for music or recreational therapy coverage under any of the following reimbursement sources?

CLASS waiver YES waiver CBP Workforce Wellness Special education The Parent-Directed Special Education Services (PDSES) program Health Savings Account (HSA) Flexible Spending Accounts (FSA) Music therapy grant None

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.