Fees & Forms


Please call for session rates. Personal checks, money orders, and cash are accepted.


Confidentiality is strictly enforced to protect the client’s privacy. According to law and professional ethics, exceptions to confidentiality exist if there is clear and present danger that someone's life may be at risk or if there is suspected child abuse or neglect. Consider also that when insurance benefits are used, the insurance company may have access to a certain amount of information.

A Note on Insurance

Although it may sometimes be financially necessary to use insurance benefits to pay for therapy, there are several important factors to consider first:

All insurance claims require a medical diagnosis, even if one doesn’t exist. This can affect or limit future insurance coverage and may inhibit certain employment opportunities.

The insurance company, not you, decides how many sessions are appropriate for your treatment. Your private information, even under new privacy policies, may be required from the insurance company for reimbursement.

Stacie accepts Pacificsource. However, the good news, is that many insurance companies have “Out-of-Network” benefits, and after a deductible is met, sessions are often covered at 50 or even 80 percent. This is individual and specific to each and every plan and something you should discuss with your benefits manager at work.

New Client Forms

New Client Forms Packet

New clients should download and complete the forms in this PDF file.

Client Forms

Informed Consent for Online Counseling

Acknowledgement of Receipt of Privacy Policies and Procedures and Acknowledgement and Understanding

Client Information Form

Health History Form

Confidentiality Policy

Court Appearance Policy

Social Media Policy

Credit Card Information Form

Health Insurance Information Form