Counseling Practice Information
Click here to download and print Consent and HIPPA Forms: |
![]() Download PDF Forms |
Click here to download and print Printable Receipt for Services: |
![]() Download PDF Form |
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
Individual counseling sessions are $160.00.
Marital, couples, and/or family counseling sessions are $200.00.
Initial visits are 50-minute sessions. If the session is shorter or longer the fee may be adjusted accordingly. If I am an in-network provider for your 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.
If I am not in your insurance network, you will be provided with a receipt that you may file with your insurance company. The fee is due at the time of the session. Please note, if insurance is being before they will reimburse you for my services, I will discuss with you the diagnosis I plan to render, if you wish, before your file claims with your insurance company, Any diagnosis made will become a part of your permanent health record.
Appointments and Cancellations
Appointments can be scheduled by calling 281-907-1314 or by visiting www.davidparmer.com. I do request 24-hour advance notice for cancellations in order to use the time for another patient. With less notice you will be charged/billed the amount for the session.
Confidentiality
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 you disclose abuse/neglect of a child or the elderly. If it is understood that you could harm yourself or others, your guardian (if the client is a minor) and/or 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 visit www.davidparmer.com. 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.
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 ($200.00) is applied time involved.