Stacey Bruen - Licensed Professional Counselor - Nationally and Board Certified
Proceedure & 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.  
Stacey prides herself on being the only individual you will be connecting with. 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 evaluation process. The forms are ethically required and the questionnaire provides valuable information to utilize throughout the  counseling process.

ADULT COUNSELING:


1 AdultIntake.pdf (PDF — 224 KB)





CHILD/TEEN THERAPY:





Additional Forms:
FAMILY/COUPLES COUNSELING:





This written document is intended for the participants in family therapy or couples counseling.  This paperwork confirms that if this counselor works with a couple or family, she will consider that couple or family (the treatment unit) to be the patient/client.






This written document is needed for all Court appointed Safe Haven/Harbor appointments: 
SAFE HAVEN.pdf (PDF — 65 KB)




As a clinician working at the intersection of Domestic Relations (DR) and counseling, it is essential that the differences in the roles be clarified. The Domestic Relations forms are required for any participate in a divorce type situation where children are involved. I WILL NOT TESTIFY IN COURT and I WILL PROTECT YOUR CHILDREN'S RECORDS. Please make sure you fill out all the paperwork and have BOTH parents sign consent forms for your child(ren). This is Stacey's policy and she will ONLY see a child/adolescent  if BOTH guardians have signed the consent to treat form.





This 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 (480-948-1123) as soon as possible or
a full session fee applies.

Insurance Information:Stacey Bruen may/may not participate with third party payers, such as managed care organizations and insurance companies.  If you are planning on utilizing your insurance,  it would be your responsibility to call your insurance company to find out your mental health benefits. If you are using an insurance program, she will supply you with a superbill that you can turn into your insurance company so they can directly reimburse you.  
   Payment is expected at the time of service. 
+++If you are calling your insurance provider they may ask for a Tax ID #: 90-1073435 and/or NPI (National Provider Number):1134424187.
Initial session is billed under CPT code: 90791 all other session billed CPT code: 90834


    It is of utmost importance to make sure your child or loved one is not at risk to him/herself. If you feel or think he/she is having any thought or feelings about hurting him/herself or killing him/herself please take measures to assure his/her safety. Support resources: going to the Emergency room; calling the Banner Help Line at 602-254-4357; or Impact at 480-784-1500; and obviously 911 if a severe crisis situation.