LPCA Professional Disclosure Statement
Erik Messinger, M.A., LPCA, NCC
I am pleased you have selected me as your counselor. This document is designed to inform you about
my background and to ensure that you understand our professional relationship.
My Qualifications
I received a Masers of Arts in Clinical Mental Health Counseling in 2016 from Indiana University of
Pennsylvania. I have been serving individuals, children, adolescents, and families for the past year and a
half. I am a National Certified Counselor (NCC #755994) endorsed by the National Board of Certified
Counselors.
Restricted Licensure
I am currently pursuing licensure as a Licensed Professional Counselor Associate in North Carolina. I
am working towards a provisional license and will be supervised regularly. I am working under the
direct clinical supervision of Courtney B. Walters, MA, LPCS, NCC. She can be reached at
cbwalte2@[Link].
Counseling Background
As your counselor, my goal is to support you in making meaning, creating a comfortable environment,
and facilitating resources to meet you where you are and help you be your best self. I utilize a person-
centered approach with cognitive-behavioral and solution focused techniques to provide a safe and
supportive space where we can collaborate to reach your goals. I work with a variety of clients from
various backgrounds. The majority of my clinical experience has involved working with clients
managing substance abuse, depression, anxiety, grief and loss, transitions, and other mental health and
life concerns.
I have one and half years of post-master’s experience working with adults, children, adolescents,
families, and groups. Prior to moving to North Carolina, I worked as a counselor providing individual
and group therapy along with intake assessments in a community outpatient setting that focused on
substance abuse and mental health. In this role, I also worked with clients recently released from
incarceration, clients on probation, and clients currently incarcerated.
Session Fees and Length of Service
Services will be provided in a professional manner consistent with the accepted clinical standards of
care. Sessions will last 50 minutes. My fee is $100 per session, payable by check or cash at the end of
each session. If you have insurance coverage, you are responsible for submitting the request for
reimbursement to your insurance company. In cases of special need, I will work with you to develop a
payment plan, which may include a sliding scale fee. The determination to use a sliding scale will be
based on a case-by-case basis. If we decide to move forward with a sliding scale option, we agree that
you will pay $_________ per session.
2
Use of Diagnosis
Some health insurance companies will reimburse clients for counseling services and some will not. In
addition, most will require that a diagnosis of a mental-health condition and indicate that you must have
an “illness” before they will agree to reimburse you. Some conditions for which people seek counseling
do not qualify for reimbursement. If a qualifying diagnosis is appropriate in your case, I will inform you
of the diagnosis before we submit the diagnosis to the health insurance company. Please be aware that
any diagnosis made will become part of your permanent insurance records.
Confidentiality
All of our communication becomes part of the clinical record, which is accessible to you upon request. I
will keep confidential anything you say as part of our counseling relationship, with the following
exceptions: (a) you direct me in writing to disclose information to someone else, (b) it is determined you
are a danger to yourself or others (including child or elder abuse), or (c) I am ordered by a court to
disclose information. I take confidentiality seriously and I am happy to answer any questions you
may have about the privacy of your information at any time. If we happen to run into each other
outside the office I will maintain confidentiality by not acknowledging you unless you choose to
acknowledge me first. If you desire, you are welcome to introduce me to those you are with as you
see appropriate.
Complaints
Although clients are encouraged to discuss any concerns with me, you may file a complaint against me
with the organization below should you feel I am in violation of any of these codes of ethics. I abide by
the ACA Code of Ethics ([Link]
North Carolina Board of Licensed Professional Counselors
P.O. Box 77819
Greensboro, NC 27417
Phone: 844-622-3572 or 336-217-6007
Fax: 336-217-9450
E-mail: Complaints@[Link]
Acceptance of Terms
We agree to these terms and will abide by these guidelines.
Client: ___________________________________________________ Date: ___________
Counselor: ________________________________________________ Date: ___________
