MUSIC THERAPY EFFICACY SURVEY

By proceeding with the survey, you indicate that you understand the purpose, your voluntary involvement, and
give consent for the use of the provided information for research purposes.

Please answer each question honestly and to the best of your ability.

PERSONAL DATA

1. How old are you? __________

2. _____Male _____Female

3. Type of procedure: ______________________________

4. What type of music do you prefer to listen to? _________________________

5. How would you rate your pain on a scale of 0-10?

BEFORE music therapy intervention

(0) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

SATISFACTION SURVEY

1. How satisfied were you with your pain control during this hospital stay on a scale of 0-5?

(5 being completely satisfied) (0) (1) (2) (3) (4) (5)

2. Did you find that listening to the music helped with pain relief?

(0 not at all- 5 extremely helpful) (0) (1) (2) (3) (4) (5)

3. How would you rate your pain on a scale of 0-10 after the music therapy intervention?

AFTER music therapy intervention

(0) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

All personal data collected will be kept confidential and used solely for research purposes. Your responses
will be aggregated and anonymized, ensuring that individual data remains confidential.