Florida Medical Psychology Associates, LLC

Please download and fill out the following forms prior to your first appointment with your provider (except for the FMPA Minor Confidentiality Form, which is only required by parents of individuals who are younger than 18 years old, and the Release of Confidential Information Form is only required if you would like your provider to communicate with someone such as your primary care doctor or a family member).   Your provider will go over the forms with you at your first appointment.  


Adults:

Demographic

Consent 

Agree to Pay 

HIPAA Notice

Release of Confidential Information 

Adult Screening Questionnaires 


Minors Only:

FMPA Minor Confidentiality 

Adolescent Questionnaire



12167 West Linebaugh Avenue, Tampa, Florida 33626, (813) 386-6800

(813) 891-1311 FAX

(Office Park is located behind the Publix on the corner of W. Linebaugh Ave. & Countryway Blvd. in Westchase)