ONLINE FORM:

Please prepare an iPod pre-loaded with music for use by:

Ordering Party:

Relation to user:

Address:

City:

State:

Zip:

Phone Number:

Ship to: (if different):

Relation to User:

Address:

City:

State:

Zip:

The iPod (check one):
I will supply the iPod and ship it to Well-Tuned Program/IMNF for loading. Please ship to:

Well-Tuned Program/IMNF
612 Allerton Avenue
Bronx, NY 10467

Well-Tuned Program/IMNF should purchase the iPod on my behalf.
(We recommend the new iPod shuffle, which can hold more than 400 songs. The $49 cost [plus tax] will show up on your credit card bill as a charge directly from Apple®.)
The Music
It is important to note that music is a separate charge, and that the recommended number of songs to start is between 100-200. All music is purchased from Apple’s iTunes Store® and will appear on your credit card as a charge from Apple® directly.

The Service
Our licensed music therapists or other specialists will create a customized playlist of music for each individual based on their input and/or the input of their family members or caregiver. The IMNF will purchase and load the music onto your iPod, provide headphones, an AC Adapter for recharging the battery, and provide instructions as to its use.

The service costs $99* (plus $10 shipping and handling).

*The IMNF and Well-Tuned: Music Players for Health complies with all regulations regarding the purchase and replication of licensed music materials.