New Patients

Hendrick Counseling Welcomes You!

New Patient Information

New patients, we require that your paperwork be completed 48 hours prior to your initial appointment.  You have several options:

  1. Our patient portal
  2. Print the forms below and email them to us at
  3. Fax your completed forms to 615-453-7051
  4. Come by our office Monday – Thursday 8-5 and fill out your paperwork.

If you are unable to complete your paperwork for any reason, we ask that you contact our office prior to the 48 hours and let us know how we can help you.

A copy of the privacy notice can also be obtained at your visit if you wish to have a hard copy. Please Note:  “Fillable” can be completed and emailed to our office.

Adult Counseling Form
Child/Adolescent Counseling Form
Anger Management Protocol

Fillable Forms: *
Adult Counseling Form (Fillable)
Child/Adolescent Counseling Form (Fillable)

These are downloadable in .pdf (Adobe Acrobat Reader) format. Please visit to download Acrobat Reader, if necessary. Click on form to open, download and print or complete.

* How to use fillable forms with Adobe Acrobat:

  1. Click on the link to open the form
  2. Click the “download” link at the top right of the form (this will show the fillable fields)
  3. Either save this form to your computer, open and complete or complete the form online and save
  4. IMPORTANT: Make sure you save the file as “Acrobat” when you are done completing your info.
  5. You can then print or email the form.

For your convenience, we now accept Visa, MasterCard, HSA cards, and Debit Cards (Note: Payments made using these methods will incur a $3.00 processing fee)

Please read these important notes.

  • Cancel 24 hours in advance if unable to keep an appointment
  • Deductibles and co-pays are expected prior to the start of your session
  • If you are sending your minor child in independently for a session, please ensure that he/she has the appropriate payment required
  • Office weather policy: If the Lebanon City Schools/Lebanon Special School District is closed due to inclement weather, our office is also closed. If the school closure is on a Friday, our office will be closed that Saturday, as well.

* Do not bring children to adult sessions

Hendrick Counseling Services

Listening Because We Care

Information presented at is for educational purposes only and is not a substitute for medical or mental health advice or treatment for specific medical or psychological conditions. You should seek prompt medical care for any specific health issues, and consult your physician before starting a new health or fitness regimen. Use of this online service is subject to this disclaimer and the terms and conditions. Please read our PRIVACY STATEMENT.
Share This