Hendrick Counseling Welcomes You!
New Patient Information
New patients, please print and complete the forms below to prior to your initial visit. We prefer to have your forms completed prior to your arrival in our office to make your visit as efficient as possible. 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.
These are downloadable in .pdf (Adobe Acrobat Reader) format. Please visit https://get.adobe.com/reader/ to download Acrobat Reader, if necessary. Click on form to open, download and print or complete.
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.
- PLEASE BRING AN UPDATED INSURANCE CARD TO YOUR OFFICE VISIT.
THIS IS ESSENTIAL TO FILE WITH YOUR INSURANCE COMPANY IN A TIMELY MANNER.
- Cancel 24 hours in advance if unable to keep an appointment
- Arrive 15 minutes early to complete necessary paperwork
- 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.
- If you are in need of a medication refill, please have your pharmacy fax your request to 615-453-7051 and allow two business days for processing.
* Do not bring children to adult sessions
However, please note that not ALL of our providers are in-network with each and every insurance company. If you have further questions regarding coverage, please call the office at 615-449-9611