DEANNA M. STASSI, MA, LPC


LICENSED PROFESSIONAL COUNSELOR


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Forms



New clients please complete the forms below for your first session:


Informed Consent

Registration

HIPAA Notice of Privacy Practices (for reading purposes only)

Acknowledgement of Receipt of "HIPAA Notice of Privacy Practices"

Intake Information

Cancellation Policy

Social Media Policy

Electronic Communications Policy

Assessment

If you are interested in Telehealth (video or telephone sessions):

Telemental Health Informed Consent



Other forms to be completed as needed:

Complaint Form

Authorization for the Release of Personal Health Information



Payments:

To make a secure online payment to your account through Square:



Square Payments

Certifications and Associations




CALL TODAY: 314-562-7796

11100 Mueller Road
Suite 1
St. Louis, Missouri 63123



deanna@deannastassi.com