Counseling Practice Information
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Consent and HIPPA Forms:
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Printable Receipt for Services:
After you read and print the form, please fill out and sign them. Retain copies for your records. Bring the completed and signed form with you on your first visit.
Payments and Insurance Reimbursement
My fee for a counseling session is $130.00. Initial visits are 50 minute sessions. If the session is shorter or longer the fee may be adjusted accordingly. If you are using an in-network insurance company, our office will file for you. Insurance must be verified prior to your first visit by calling 281-907-1314 or visiting www.davidparmer.com. You will be responsible for your co-pay or deductible. Should your insurance company not pay your claims your balance is your financial responsibility.
I will keep notes regarding your counseling sessions; however, those notes will not be revealed to anyone without your written permission. I cannot disclose to anyone that you are in counseling without your written permission. The only times that confidentiality could be broken is if it is disclosed that abuse/neglect of a child or the elderly has occurred. If it is understood that you could harm yourself or others and/or your guardian (if the client is a minor) law enforcement will be notified. Confidentiality could be broken if a courtroom judge orders me to disclose information gathered in counseling sessions. Also, if you are filing information with your insurance company they may require disclosure of some details to pay for your counseling sessions.
Contacting David Parmer
If you need to contact me between sessions, please call 281-907-1314 or e-mail me at firstname.lastname@example.org. You may leave a message and I will return your call usually within 24 hours or less. In an emergency you may need to call 911 or go to the nearest hospital emergency room.
Appointments and Cancellations
Appointments can be scheduled by calling 281-907-1314. I do request 24-hour advance notice for cancellations in order to use the time for another patient. With less notice or not keeping your appointment – you will be billed the amount I would have collected from your insurance or self-pay. This is time set aside for your use and I’m not always able to fill a time slot with less than 24 hours notice.
Testifying in Court
Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters which may be of a confidential nature, it is agreed that should there be legal proceedings neither you nor your attorney’s, nor anyone else acting on your behalf will call me to testify in court or at any proceeding nor will a disclosure of the psychotherapy records be requested. Should I receive a subpoena by the court, my individual hourly fee is applied to my time regarding your case in and out of court.
Divorced Parents with Under Age Children
If you are divorced and your child who is under the age of 18 is going to be receiving counseling services – you should bring a copy of the divorce decree to your first counseling appointment. The only exception will be if both biological parents are present for the appointment. Counseling can only be provided to children of divorce with a copy of custody documents.