Procedure and Policy Information

Once you have scheduled an appointment, please download and fill out the appropriate paperwork that coincides with the treatment you are seeking. The completed intake forms will provide valuable information and reduce the amount of time in session gathering historical/relative information.

I take pride in providing personal and one-on-one counseling sessions. This allows for complete confidentiality and discretion. Any questions regarding billing, treatment, or scheduling, all go through Stacey.

Paperwork

Please bring these completed forms to your first session in order to expedite the initial intake process. The forms are ethically required, and the questionnaire provides valuable information to utilize throughout the counseling process.

Adult Counseling

Adult Intake Paperwork

Child/Teen Therapy

Child Adolescent Intake

Family/Couples Counseling

Consent Treat Family Couple Document

Domestic Relations Form: As a clinician working at the intersection of Domestic Relations (DR) and counseling, this form is deemed necessary in order for the role in therapy be clarified. The DR form is required for any participant in a divorce type situation where children are involved.

Teletherapy Consent Form: This signed document is required for all Teletherapy and phone sessions.

Safe Haven Form: This written document is needed for all court-appointed Safe Haven/Harbor appointments.

Release of Confidential Information Form: is required if you prefer this counselor to coordinate treatment (provide or receive information) with another professional, such as a psychiatrist, physician, court ordered specialist, etc.

Stacey has a cancellation policy, so if for some reason you are not able to attend your appointment, please phone the office within 48 hours of your appointment at 480-948-1123.

Support Resources

Call 911 in the occurrence of a severe or crisis situation.

If in immediate crisis, call the Banner Help Line at 602-254-4357 or Impact at 480-784-1500.

If an Emergency go to the closest emergency room.

Insurance Information - Make a Payment