The fee schedule of PAR Counseling Services, LLC, is based on usual and customary fees for the type of services provided. Payment for services is due on the day of the appointment.

In the event of a cancellation, notification must be provided within 24 hours of the scheduled appointment. If notification is not made within 24 hours, the penalty for a “no show” is $50. The rescheduling of an appointment will not be made until the balance is paid in full. Additionally, if three or more “no show” appointments occur in a six month period, the client shall be discharged from treatment.

Generally, your insurance policy will cover some portion, if not all, of the payment for services provided. There is, however, no guarantee of payment. The balance amount that your insurance carrier does not cover will be your responsibility. You are also responsible for any deductible and co-pay. We request that any insurance payments that are sent directly to you be presented promptly to PAR Counseling Services, LLC, along with the explanation of benefits and/or any other information you received with the payment.

Monthly statements will be sent to you if you have an outstanding patient balance. I attest that my insurance coverage and personal financial responsibilities regarding mental health counseling services have been fully explained to me.

This notice describes how the medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully.

As your professional counselor, we care about your privacy and strive to protect the confidentially of your medical information in this practice. Federal legislation requires this notice of privacy practices. You have the right to confidentiality of your medical information, and this practice is required to abide by the terms of the Notice of Privacy Practices currently in effect, and to provide notice of its legal duties and privacy practices respond to protect health information.

Who Will Follow This Notice

Any health care professional authorized to enter information into your medical records, all employees, staff, and other personnel at this practice who may need access to your information must abide by this notice. All subsidiaries, business associates, sites and location of this practice may share information with each other for treatment purpose of health care operations described in this notice. Except where treatment is involved, only the minimum necessary information needed to accomplish this task will be shared.


How We May Use and Disclose Medical Information About You

The following categories describe different way that we may use and disclose medical information without your specific requires or written authorization. Examples are provided for each category of uses or disclosures. Not every possible use or disclosure in a category has been listed.

-Treatment: We may use medical information about you to provide you with medical treatment services.
Example: In treating you for a specific condition we may need to know if you have other condition that may affect your treatment.

-Payment: We may use and disclose medical information about you so that the treatment and services you receive from us may be billed and payment may be collected from you.
Example: We may need to send our protected health information, such as your name, address, office visit date, and codes identifying your diagnosis and treatment to our billing services for processing.

-Health Care Operations: We may use and disclose medical information about you for health care operations to ensure that you receive quality care.
Example: We may use medical information to review our treatment and services to evaluate the performance of our staff in caring for you.


Other Uses or Disclosure that can be made Without Your Written Consent or Authorization

-As required during an investigation by law enforcement agencies

-To avert a serious threat to public health or safety

-As required by military command authorities for their medical records

-To worker's compensation or similar programs for processing claims

-In response to a legal proceeding

-To a coroner or medical examiner for identification of a body

-For an inmate, to the correctional institution or a law enforcement official

-As required by the US Food and Drug Administration


We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be in the best interest of you.


Uses of Disclosures of Protected Health Information Requiring Written Consent

Other uses and disclosure of medical information not covered by this notice of the law that apply to this practice will be made only with our written authorization. If you give us authorization to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will thereafter no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosure that we have already made with our permission and that we are required to maintain records of the care we have provided to you.