|
Hendrick Counseling Welcomes You!
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.
Authorization For Release
Confidentiality Policy
Consent to Treat
Insurance Company Info
Patient Information Sheet
Help Us Help You Sheet
These are downloadable in .wps (Microsoft Word Perfect) format,
which is compatible with Microsoft Word as well. Right-click and print.
|
 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
- We accept cash and
personal checks only
- If you are sending your minor child in
independently for a session, please ensure that he/she has the
appropriate payment required.
- Office snow 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
|
Insurance
Information
We currently participate with Insurance Companies, INCLUDING but
not limited to:
1. Blue Cross Blue Shield
2. United Health Care
3. United Behavioral Health
3. Healthscope
4. Magellan
5. Medicare, (Amerigroup and Americhoice for
children only)
6. Cigna
7. Phcs
8. Aetna
9. Compysch
10. Horizon Healthcare
11. Fiserv
12. Ceridian
13. Tricare
14. Valueoptions
15. EAP Programs
If you have further questions regarding coverage, please call
the office at 615-449-9611
|
"Listening Because We Care" |
