Contact Constance

For more information on working with me, see the participation page.

I will get back to you as soon as I am able. I check my email each day, but sometimes I get busy so please be patient.

Please select a reason for contacting me:

General Contact

Each area is required for me to contact you. Please fill out the form below and tell me a little about yourself and what you are interested in discussing.

Name
Email
Subject

Contact for Free Consultation

Each area is required for me to contact you. Please fill out the form below and tell me a little about yourself and what you are interested in discussing.

Name
Email
Subject
Select the program that interests you.

Application for Ongoing Sessions

Mental Health Client Rights Statement
Constance Casey, Spiritual Facilitator

www.constancecasey.com


Constance has a Bachelor of Science Degree and a Chemical Dependency Counseling Degree with a background in process addictions and her spiritual self-training is varied, including 12 Step work with intensive Zen and Vipassana training in mindfulness meditation studies since 1983. Constance is also training in the Community Dharma Leader Program through Spirit Rock in California.

THE STATE OF MINNESOTA HAS NOT ADOPTED UNIFORM EDUCATIONAL AND TRAINING STANDARDS FOR ALL MENTAL HEALTH PRACTITIONERS. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATION PURPOSES ONLY.

If for some reason you need to file a complaint about this unlicensed mental health practitioner, you may contact the Office of Mental Health Practice, Minnesota Dept. of Health, PO Box 64975 St. Paul, MN 55164. 1-800-657-3957.

Client Counseling Agreement

  • I understand that Constance Casey is a facilitator who works from a non-denominational spiritual framework that she has evolved out of her own spiritual experiences, and from a synthesis of traditional and non-traditional sources.
  • I understand that she is not a psychologist or psychotherapist. I understand that I have a right to complete and current information regarding her assessment and recommended course of treatment, and the expected duration of treatment.
  • I understand that I am free to seek any other services I choose while I am working with Constance, and that if she perceives that I have challenges that go beyond the scope of her experience she will refer me to appropriate resources.
  • I know that I am entitled to courteous and respectful treatment free from verbal, physical, or sexual abuse from any caregiver, and that my sessions with Constance are confidential.
  • All records and transactions of my work with Constance are confidential unless I authorize their release, and are available to me at any time, in accordance with Minnesota Statutes section 144.335 .
  • I understand that I have the right to refuse services or treatment, unless otherwise provided by law, and that I may assert my rights without retaliation from the practitioner.
  • I consider myself capable of using Constance's guidance in a mature way and will "take what's good for me, and leave the rest."
  • I acknowledge that I am responsible for my own growth, my own decisions, my actions and their consequences.

Payment Agreement

Your payment is for her commitment to a mutually agreeable scheduled amount of time with her for her expertise and experience.

Payment is due on the day of service in cash, by check or PayPal. Constance does not take insurance. Constance's fee is $75 - $125/hr for in person or phone counseling and $50 - $75/hr for group sessions. You and Constance will agree to the amount prior to your first session. You will be notified in a reasonable amount of time in advance of any changes in services or charges.

Cancellation Policy

There is no cancellation charge for sudden illness or emergencies. Constance requests 48 hour notice for rescheduling your appointment if possible. If you cancel in less than 24 hours of your scheduled time, you are responsible to pay for the missed session.



Contact Information
First Name
Last Name
Email Address
Street Address
City
State
Zipcode
Home Phone
Work Phone (optional)
Date of Birth

Background Information
Are you currently or have you ever been in ongoing counseling or psychotherapy?
No Yes. If so, please explain below.


Are you currently under the care of a psychiatrist or taking any psychiatric medications?
No Yes. If so, please explain below.


Please briefly describe your meditative experience?


Are you aware of any dysfunctional patterns in the family you have come from?
Alcoholism
Abuse - Physical
Abuse - Sexual
Abuse - Emotional
Workaholism
Food Disorders
Physical Neglect
Emotional Neglect
Mental Illness
Sex Addiction
Other

Are you struggling with any addictive behaviors at this time?


What kind of a religious background (if any) do you have?


Do you practice spirituality in any specific manner at this time?
No Yes

At this point in your life, what do you consider to be your greatest strength?


What do you consider to be your greatest challenge?


What do you consider to be your goals for practice?


Clicking 'Submit Client Information' button
  1. Acknowledges you have read 'Client Rights Statement' and
  2. Serves as your signed signature.