Individualized Music Therapy Assessment Profile

(IMTAP)
Cover Sheet
Intake Date:
Year Month Day

Clients Name: Sex: M F Birth Date:

Year Month Day

Therapists Name: Chronological Age:

Years Months Days

Additional Assessment Date(s): Date to be Reviewed:

Videotaped: ____ Yes ____ No

Domains to be assessed (please check):

Gross Motor
Fine Motor
Oral Motor
Sensory
Receptive Communication/Auditory Perception
Expressive Communication
Cognitive
Emotional
Social
4 Musicality

Please use the following guidelines to assist in the assessment process:

1. Assessment to be completed in 13 individual MT sessions by the same therapist.
2. Assessment to be recorded on video when possible.
3. Activities, music, instruments, techniques used to be indicated in each category.
4. Multiple responses may be assessed within one activity.

Rating
N = Never = 0%
R = Rarely = Under 50%
I = Inconsistent = 5079%
C = Consistent = 80100%

Holly Tuesday Baxter, Julie Allis Berghofer, Lesa MacEwan, Judy Nelson, Kasi Peters and Penny Roberts 2007