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Read Paperwork Policy


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.


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

Child/Teen Therapy

Family/Couples Counseling

As a clinician working at the intersection of Domestic Relations (DR) and counseling, I deem it is essential that the differences in the roles be clarified. The Domestic Relations forms are required for any participant in a divorce type situation where children are involved. 

Domestic Relations Document

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

Release 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 24-hour cancellation policy, so if for some reason you are not able to attend your appointment, please phone the office at 480-948-1123 as soon as possible or a full session fee applies.

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