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Mushroom Grove Collective

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Reason for care

Select date & time

1 Appointment info

Reason for care

3 Contact information

What is the reason for seeking care?

Anxiety Autism ADHD CPTSD Relationship issues EMDR Other

What kind of care is being sought?

Individual Therapy Couples Therapy Other

What mental health treatment have you received in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Working with a psychiatrist now Worked with a psychiatrist in the past Received coaching now or in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past None of these apply

What are your goals for therapy?

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If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

Johanna Stacy, M.A., LMHC, EMDRIA Certified Therapist™

503.406.8106 |

Camas, Vancouver, Washington

Notice of Privacy Practices

No Surprises Act

You have the right to receive a Good Faith Estimate of what your services may cost.

Main Location

750 Officers Row
Vancouver, WA 98661-3845

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.