Call us: 754-210-7175
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Forms
To expedite the intake process, parents are asked to bring the completed packet to their first appointment with the psychologist. Once the initial appointment is scheduled, the following forms must be completed and brought in to the initial appointment.
Assessment Form - English
Fees for Services
TERMS OF PAYMENT:
Pediatric PsychSolutions, P.A. is a fee-for-service practice, and it does not accept or process insurance claims. We accept Visa, Mastercard, Debit cards, and Checks as forms of payment. Upon request, we are happy to provide our clients with an itemized receipt of all services and complete a commonly accepted insurance claim form for them, which they can then submit to insurance companies for reimbursement consideration as services received from an out-of-network provider.
Payment for clinical services is due at the time services are rendered. Payment for school-based consultation/support service charges are due in full 72 hours prior to scheduled meeting. For psychological evaluations, clients are asked to pay 50% of the fee on the day of the interview. The balance must be paid in full prior to the feedback session.
The following is a list of the fees for our services. The Bio-Psychosocial interview, the direct contact hours, the feedback session, and a comprehensive written report are included in the psychological evaluation fee. If unsure of whether or not your child or adolescent is in need of an evaluation, please contact us. We will gladly provide assistance with a brief complimentary phone consultation.
CLICK HERE FOR A SAMPLE OF AN ITEMIZED RECEIPT
