MUSIC THERAPY ASSESSMENT

Name_____________________________________________DOB_______________Age___
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Diagnosis____________________________________________________________________
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Assessment
Date(s)____________________________Therapist__________________________
Check all areas that are applicable. Use (+) for usually; () for sometimes;
(-) for rarely
COMMUNICATION:
Additional
Comments:
1. Client makes eye contact
____
2. Client verbalizes choices of activity/
instrument/song
____
3. Client can state his/her own needs
____
4. Client can listen to others
____
5. Client demonstrates appropriate gestures
6. Client can fill-in-the-blank
____
7. Client understands directions
____
8. Client can answer questions
____
9. Client engages in call-and-response
____
10. Articulation of speech
Intelligible ____
Fairly Intelligible____
Unintelligible
____
COGNITIVE
1. Client identifies concepts such as
colors, numbers, letters, body
parts, shapes, etc.
2. Client identifies changes in tempo
And dynamics
3. Client repeats simple/complex
Rhythms
____
4. Client recalls melodies and themes
5. Client plays a steady beat therapist
6. Client plays loud/soft with therapist

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7. Client can remember lyrics of songs

8. Client can repeat simple melodies

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SOCIAL:
1.
2.
3.
4.
5.

Client participates in musical activities ____

Client makes and maintains eye contact
Client greets and uses gestures to others
Client converses with others
____
Client demonstrates appropriate
Response to activities
____
6. Client can identify sources of support ____
7. Client passes and shares instruments ____
8. Client engages in improvisation
____
9. Client responds to name
____
10. Client acknowledges others
____

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MOTOR:
1. Client can play piano with more than
two fingers
____
2. Client can participate in signing
activities
____
3. Client can clap during a song
____
4. Client can point to body parts
____
5. Client can imitate basic movements,
using upper and lower extremities
and trunk, through song
____
MUSIC:
1. Client sings in pitch
2. Client can finish musical phrase
3. Client identifies structure and form
4. Client can choose a song or style
5. Client matches/imitates rhythm
6. Client keeps a steady beat
7. Client adapts to rhythmic changes
8. Client adapts to changes in volume
9. Client chooses an instrument
10. Client uses instruments expressively

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EMOTIONAL/AFFECT
1.
2.
3.
4.
5.
6.

Client
Client
Client
Client

displays range of affect

____
expresses feelings on instrument
shows feelings through words
____
identifies his own mood/emotions

____
____

Client shows appropriate facial expression _____

Client expresses likes/dislikes

____

Assessment Summary

Recommendations:

Therapist_______________________________________________Date________________
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