Appointment Request Form

Appointment Request Form

Evaluations/Therapy/Parent Coaching
Welcome to Child and Adolescent Psychology of Tampa Bay

Thank you for visiting our website and for your inquiry into our services. We are here to help you navigate any difficulties your child may be experiencing, both at home and at school.

We offer a range of evaluation services including screenings, diagnostic assessments, and psychoeducational testing. Treatment options include individual therapy, parent-child therapy, school behavior support, and parenting services. We work with toddlers to young adults. Our services address a range of pediatric and young adult challenges including attention deficit/hyperactivity disorder, oppositional defiant disorder, autism spectrum disorder, anxiety, perfectionism, learning disabilities, and behavior problems.

Self-Pay Fees:
All New Clients
Initial Consultation: $200

Individual Therapy/Parent Coaching
45 Minute Session: $150

Evaluations
ADHD Evaluation: $800 - $2,500
Autism Evaluation: $800 - $2,500
Psychoeducational / Psychological Testing: $1,600- $2,500
Gifted Testing (IQ): $400

All evaluations are individualized to meet your needs so fees may vary. Additional cost will be determined based on the extensiveness of evaluation procedures (beyond our basic diagnostic battery), medical history, and related record review required to answer complicated referral questions such as differential diagnoses.

Payment plans are available for evaluations as needed. Credit/debit, cash, and HSA/FSA cards are accepted.

Insurance:

We do not bill any insurance companies directly. For insurance claim purposes, we are considered an out-of-network provider. An invoice can be provided by request for those that would like to submit for out-of-network reimbursement.

Updated December 2023
Your Name

First NameLast Name
Your Gender
Your Relationship to the Child
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Age
Child's Gender
Child's School and Grade
What type of services are you looking for? Select all that apply

Psychoeducational EvaluationGifted TestingADHD EvaluationAutism EvaluationParent-Child Interaction Therapy (Ages 2-8)Individual Therapy (Ages 5-25)Group TherapyEvaluation for Board Exam Accommodations (i.e.: SAT/ACT, GRE, LSAT, etc)
Please describe your current concerns with your child
Please list any mental health diagnoses your child has received (professionally diagnosed)
Please list any suspected mental health diagnoses
What would you like to gain from our work together?
Any questions or additional information?
How did you hear about our practice?
Please verify that you are human*
Should be Empty: