Your Name *

First Name

Last Name

Phone *

(###)

###

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Date of Birth *

MM

DD

YYYY

Child's Name

First Name

Last Name

Child's Date of Birth

MM

DD

YYYY

What services are you interested in? *

Child Therapy

Adolescent Therapy

Young Adult Therapy

Parent Support Sessions (Child Not Present)

Psychological or Psychoeducational Evaluation

Pregnancy or Postpartum Counseling

Help Me Decide

Like most specialty providers, we are not in-network with any insurance company, but can help you file out-of-network claims for reimbursement. *

Intake Assessment: $300. Therapy Session with Licensed Psychologist: $225.

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