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:
- Our patient portal
- Print the forms below and email them to us at counseling4you@bellsouth.net
- Fax your completed forms to 615-453-7051
- Come by our office Monday – Thursday 8-4:30 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.
Adult Counseling Form
Child/Adolescent Counseling Form
Anger Management Protocol
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 $5.00 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
- 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.
* Do not bring children to adult sessions