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.
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
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:
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
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
session fee applies.
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
+++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.