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T-JTA® Online Scoring Notification Form
First Name:
Last Name:
Account Number:
Email Address:

Type of Group Taking the T-JTA:

Select One Type of Group.

Print-outs for the Counselor

Select One Type of Scoring Output for the Counselor.

Print-outs for the client (optional):

Would you like to include handouts for your client?      

Names of persons taking the test:
Name #1:
Name #2:
Name #3:
Name #4:
Name #5:
Name #6:
Name #7:
Name #8:
*** List additional names of individuals or couples in the notes box.

Results Delivery Method:

One-Time Payment Method
Please insert the credit card information below. This card will be charged to pay the scoring fee for the tests listed above only.

We will automatically charge your credit card on file for any other T-JTA Online scoring services. Contact PPI at any time to change the credit card information.

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       Name as it reads on the Credit Card:
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The credit card number you entered is invalid. Please check your number and try again. Please note that we can only accept Visa, MasterCard, American Express or Discover.

      Billing Zip Code:          

Special Instructions or Notes.

View the T-JTA Online Scoring Service License Agreement

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