Treatment Services and Fees
To get started as a new client please download, print and complete the forms below and bring them with you to your first session.
Intake Forms
New Client, All Forms
New Client, All Forms (PDF, 455kb)
Individual Forms
New Client Intake Form (PDF, 97kb)
Authorization of Services Form (PDF, 81kb)
Privacy Notice (PDF, 108kb)
Patient/Client Service Agreement (PDF, 117kb)
Patient Payment and Consent Form (PDF, 86kb)
Trouble downloading files? To view and print these PDF files you will need the Adobe Acrobat Reader. If you are having trouble downloading or reading the above forms you may need to install the free Adobe Reader application. Click here to visit the Adobe site and begin your free download »
Treatment Fees
Fees for Psychotherapy:
$120.00/60 minute individual
$150.00/90 minute individual
$150.00/60 minute initial consultation and family BCBS provider
Accept and bill all insurance as out of network provider.
Fees for Movement Coaching:
Individual 1 hour movement coaching/repatterning: $120.00/hour
Sets of 5 coaching sessions: $500.00 (savings of $100.00)*
Mean What You Say Program Fees:
Initial Consultation and Evaluation (includes in-person or videotaped analysis and written report): $300.00
Presentation of Findings and First Coaching Session (includes written report and recommendations): 90 minutes, $175.00
Interim Coaching Session: 60 minutes, $150.00
Follow Up Analysis with Written Recommendations: $200.00
Full Package Program:
Includes Initial Consultation and Evaluation, Presentation of Findings and First Coaching Session, One Interim Coaching Session, Follow Up Analysis with Written Recommendations, $750.00* (save $75.00 off individual sessions).
* Must be paid in full at contract signing.
Fees for Supervision:
Individual Supervision: $60.00/hour
Group Supervision: Pricing dependent on total number in group (limit to 4 please).
Get in Touch
Contact Stacey to schedule an appointment at 630-393-9800, ext. 203 or through the contact form on this site.