Your Name *

First Name

Last Name

Phone *

(###)

###

####

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? *

A description of our services can be found in the menu bar at the top of this page.

Play Therapy

Child / Teen Therapy

College / Young Adult Therapy

Parent Consultation (Child Not Present)

Comprehensive Psychological or Psychoeducational Evaluation

Brief Diagnostic Assessment / Mental Health Consultation

Pregnancy or Postpartum Therapy (we see adults all ages)

SPACE

PCIT

Help Me Decide

What are your primary concerns? *

Select all that apply.

Attention/Hyperactivity

Attention/Concentration

Defiance

Aggression

Bedtime Issues

Excessive Worry

Social Anxiety

Separation Anxiety

Obsessive/Compulsive Behaviors

Perfectionism

Panic Attacks

School Refusal

Executive Functioning/Organization

Learning Problems

Depression/Mood

Something Else or N/A

Like most specialty providers, we do not accept insurance, but can help you file out-of-network claims for reimbursement. *

Intake Assessment: $250-300. Therapy Session with Licensed Psychologist: $225. Therapy Session with Licensed Mental Health Counselor: $175

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

Do you have a preference of location?

Note that our after-school in-person spots are limited.

Telehealth Preferred

In-Person Preferred

First Available

What time of day do you prefer your CHILD meets?

Most schools work with us to see students virtually during the day, making access to therapy very easy even during school hours.

Morning (8am-11am)

Daytime (11am-2pm)

Afternoon (2pm-6pm)

Evening (6pm-8:30pm)

Any / No Preference

What time of day do YOU prefer to meet? (Parents/Adult Clients)

Morning (8am-11am)

Daytime (11am-2pm)

Afternoon (2pm-6pm)

Evening (6pm-8:30pm)

Any / No Preference

Do you have a preference of clinician?

(For therapy clients only)

Licensed Psychologist $225

Licensed Mental Health Counselor $175

No preference/match me with the best fit