Your Information

First Name *

Last Name *

Email *

Phone *

Child Information (if applicable)

Child's First Name

Child's Last Name

Child's Age

Child's Grade

Reason for Seeking Help

What therapy services are you interested in? *

Parent-Child Behavior Therapy (PCIT, SPACE, PMT)

Therapy for Preteen/Teen (9-17 years)

Therapy for Adult (18+)

N/A

Please check below if you are seeking psychoeducational or neuropsychological testing.

Psychoeducational or Neuropsychological Testing Requested

How can we help? What are your primary concerns? Please be as detailed as possible so we can match you with the best clinician for your needs. *

Insurance & Payment

Initial Consultation with Licensed Psychologist: $375
Therapy Session with Licensed Psychologist: $225

I understand TPP does not accept insurance and I am responsible for all self-pay fees.

Scheduling

We primarily see clients virtually and have limited in-person therapy spots. We do our best to accommodate requests for in-person and after school therapy; however, we cannot guarantee a spot. All psychoeducational evaluations are in-person.

I understand TPP uses a secure video platform for Telehealth therapy.

How do you prefer we contact you?

Phone

Text

Can we leave a voicemail?

Yes, you can leave voicemail

No, do not leave voicemail

Referral Information

How did you find us? *

Do you have a specific provider you wish to work with? *

Messaging Consent

By providing your phone number, you agree to receive text messages from Tampa Pediatric Psychology. Message and data rates may apply. Message frequency varies. Reply STOP to opt out.