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New Client Information and Forms

Dr. Carmine Pecoraro Psy.D. & Associates P.A.

First Appointment Letter

“A Place for Healing & Wellness”

Thank you for Choosing Dr. Carmine Pecoraro and Associates PA . We are grateful you have chosen us for your counseling care. Please be aware that we have three (3) locations. Sometimes Google does not have the correct addresses; therefore we wanted to be sure that you have our most current locations.

10037 Water Works Lane
Riverview, FL 33578
(727) 543-7678
2708 Alternate 19 N.
Suite 507-14
Palm Harbor, FL 34683
(727) 543-7678
1650 NE 26th Street
Suite 206 Ft. Lauderdale, FL 33305
(954) 463-2723

If you are using your health insurance, please phone your insurance company to pre-certify your visit. Our Tax ID is 651154871. They will inform you of your co-payment amount, an authorization code, deductible, and the number of visits approved. Please have them fax or email this information to us at 954-463-2723 prior to your first appointment.

If you are using employee assistance offered by your employer with no copayment, you must provide proof of authorization prior to being seen. Contact the employee assistance for mental health on the back of your insurance card and ask them to fax us your authorization prior to your appointment at (954) 463-1687. In addition, request that they mail or email you a hard copy of the authorization to bring with you to your initial appointment. An authorization code without the paperwork is not sufficient as we need all of the employee assistance program information including claims address. If you do not have the employee assistance information with you or faxed to us prior to your appointment, we will need to reschedule our visit.

Please be aware that payment is due at the time service is rendered. If you need to cancel your appointment and you do not give a 24 hour cancelation notice, you will be charged a $100.00 cancellation fee. Additionally, if you do not show up for your appointment you will be charged a $100.00 No Show fee.

Prior to your first visit, please print out the and complete all intake forms and medical history form and give them to your clinician on your first appointment.  If these forms are not completed, they will need to be completed in your first appointment and may shorten this session.. Please arrive 15 minutes early to you initial session.

We look forward to meeting you. We are here to guide you in reclaiming your personal power and assisting you on the path of emotional recovery. We are known as “A Place For Healing and Wellness.”


Dr. Carmine Pecoraro Psy.D. & Associates PA

If you're a new client, please complete the following form(s) and bring to your first session.



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