Services Based out of Union, SC
864-381-7573
MA, LPC
Professional Disclosure Statement and Consent to Treatment
Professional Info: Mari Bumgarner is licensed through the SC Board of Examiners for the Licensure of Professional Counselors, Marriage and Family Therapists, and Psycho-Education Specialists. She has a Master’s Degree in Human Service Counseling and Post-Graduate education in Professional Counseling and Rehabilitation Counseling.
Contact Information: We are a mental health office seeing patients in person or via telehealth. Our physical location is 436 N. Duncan Bypass, Ste. A, Union, SC 29379. You may reach us at the above email addresses/phone numbers.
Appointments: All visits are by appointment only, which are scheduled by staff. You will be charged if you do not show and do not call. In the case of illnesses and medical emergencies, please notify staff no later than 2 hours before the appointment. Late cancellations (less than 2 hours before) and no-show appointments are billed to the client in the amount of $100.
Emergencies: As a small, telehealth practice, we are unable to always be on call. If you have an emergency, please call 911, 988, or go to the nearest emergency room. If you leave a message for staff either by listed cell phone (864) 381-7573 or email, we can promise that someone will respond to you within 48 hours. If there is an emergency in an ongoing session that a staff member is in, please know that we are tending to sensitive needs and may need to reschedule the appointment. We appreciate your patience with us. The safety and wellbeing of our clients are our number one priority.
Fees: It is customary to pay for your professional services at the time they are rendered unless discussed between the client and therapist. Fees will be received at the end of session. We accept payments through Ivy Pay or Venmo. You will be asked to provide your card number before the session begins.
Initial Consultation is free. This does not include therapy.
Individual Intake Therapy Session (60 minute session)……………………$75
Individual Therapy Session (45 minute session)………………………… $40
Life Coach Intake Session (60 minutes) ………………………………… $75
Life Coach Individual Sessions (45 minutes) …………………………….$40
Request of Records…………………………………………………………$20
At this time, we only accept Aetna.
Ethics: Our therapist follows the code of ethics of the following organizations:
• The South Carolina Board of Examiners for the Licensure of Professional Counselors, Marriage and Family Therapist, and Psycho-educational Specialists
• The Commission on Rehabilitation Counselors Certification (CRCC)
We welcome clients to Palmetto Counseling and Wellness, LLC. who we believe have the capacity to resolve their difficulties with assistance. Some of the difficulties presented by you may take weeks, months, or years to achieve. As our sessions and interactions may be very intimate emotionally and psychologically, it is important to remember that our relationship is professional and not a personal one.
Confidentiality: The information you share during sessions is generally considered confidential by the South Carolina statute law and Federal regulations. Your therapy file can be subpoenaed in South Carolina through a court order (signed only by a judge) but is considered privileged in the Federal Court system. We are mandated by state and federal regulations, through duties to warn, to breach confidentiality if staff discovers any of the following:
- you are threatening self-harm or suicide;
- you are threatening to harm another or homicide;
- A child has been or is being abused or neglected;
- a vulnerable adult has been or is being abused and neglected;
In addition to the above “duties to warn” events, please note the following additional exceptions to confidentiality:
- your name and address will be using billing processes
- you direct staff to disclose protected health information to someone else (ie., An attorney a Physician, etc.), and sign a specific consent to release information form.
Referrals
Occasionally, it may be in your best interest that you are referred to another mental health professional. Staff may also need to refer you to a physician if there are possible medical concerns. This is done on an individual basis and will be thoroughly discussed with you.
Psychiatric Referrals
There are times when a psychiatric evaluation may be necessary if your condition suggests that a psychiatric medical evaluation and/or medication may be indicated. Again, this will be thoroughly discussed with you.
Informed consent: You will be asked to sign the last page of this document. Your signature verifies that you have been given this document and the HIPAA document, you have read and understand these documents, and you consent to treatment. Please inform staff if, at any time and for any reason, you are dissatisfied with services.
