Turning Point of Tampa - Client Payment Center

Use the form below to make a payment. Please ensure that you fill out the form completely and that you fill in the 'Client Name' field. Failure to do so may delay or misdirect payment. If you have questions about this payment form, please call us before submitting the payment.

* = Required Field

Billing Contact:

First Name

Last Name

Billing Address:

Country

Address 1

Address 2

City

State

Postal Code

Phone/Ext

Payment Information:

Card Type

Card Number

Expiration Date

Card Verification Number

* What's this?

*Amount

Client Name

Entrer 'I Agree' in this field to acknowledge you have read the Refund Policies below:

Money will be applied to an escrow account?

Comments

Dont forget to enter a 'Client Name'!

Refund Policies:

For residential and partial hospitalization self-pay clients only the refund policy is as follows. We will charge the following fees regardless of the reason for discharge $3,000.00 administrative fee, $500.00 psychiatric fee, plus $325.00 per diem rate.

For intensive outpatient self-pay clients, fees are non-refundable.

For full fee agreement details please click on the appropriate link(s) below:

If you have any questions please call us for assistance.