Thank you for your interest in our services! Complete our secure online consultation form and our Intake Coordinator will follow up by email to get your intake appointment scheduled!

Prefer to talk on the phone first? Schedule a complementary phone consult instead.

Your Information

First Name *

Last Name *

Email *

Phone *

Child Information (if applicable)

Child's First Name

Child's Last Name

Child's Date of Birth

Child's School

Child's Grade

Reason for Seeking Help

What concerns are you seeking help for? *

Attention Problems

Learning Problems

Anxiety

Panic Attacks

OCD

Stress / Life Transition

Defiance

Aggression

Bedtime Problems

Eating Habits

Parenting Support

Seeking gifted testing

Pregnancy/Postpartum Counseling

N/A

Briefly share the reason you are seeking support: *

Insurance & Payment

Initial Consultation: $300
Therapy Session with Licensed Psychologist: $225
Reduced Fee for College Students: $185

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

If I have a PPO health insurance plan, or an FSA or HSA, I understand that I may be able to obtain reimbursement for services rendered. I am aware that HMO and EPO health insurance plans will not offer reimbursement of any services provided.

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.