New Patient Paperwork

Please complete the questions below. The process should take approximately 15 minutes. Once you begin, you will not be able to save your progress. If you leave before completing this process, you will need to start over. You will know you are finished when you click "Submit" and see a message that says your information has been successfully submitted.

FEES FOR SERVICE

I understand that the following fees apply for services by PMG and I agree to pay applicable fees by

Money Order Only.

PASCO COUNTY

$20     per session for group therapy

$60     per Mental Health Assessment

$60     per Anger Evaluation

$95     per Psychological Evaluation

$40     per Sex Offender Assessment

Hillsborough County

$22     per session for group therapy

$60     per Mental Health Assessment

$60     per Anger Evaluation

$95     per Psychological Evaluation

$50     per Sex Offender Assessment

Your Signature

PSYCHOLOGICAL MANAGEMENT GROUP

Main: (813) 963-1016

Fax: (813) 988-4005

7402 North 56th Street
Building 100, Suite 102
Tampa, FL 33617-7735

©2020 by Psychological Management Group