New Patient Booking

Important New Patient Information

PLEASE READ CAREFULLY BEFORE COMPLETING THE ONLINE PATIENT REGISTRATION AND HISTORY FORM

Welcome and thank you for reaching out to us to schedule your appointment with Hendricks Therapy! Please read the following important policy information prior to completing the (secure, HIPAA-compliant) Online Patient Registration and History Form.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.

Appointment Availability: We are currently accepting NEW Patients however you may be placed on a Waiting list for some services that are more in demand.

Insurance: We are in network with many commercial and government insurances, but not all. Each provider is credentialed with different insurances, so your insurance policy will have a direct impact on which provider you can see. Deductibles, co-pays, or co-insurances may still apply. *Employee Assistance Programs (EAP) can only be used for therapy appointments. For specifics on which therapists accept EAPs and which programs we take, please contact the office directly.

Medicaid/Anthem HIP: We are not in network with Medicaid (including Anthem HIP). If you have Medicaid, you can still be seen as a self-pay patient. We will still make a copy of your Medicaid card to have on file for any prescriptions, but we will not file a claim with Medicaid for your office visit. You will be responsible to pay for the cost of your visit.

Patient Engagement: We can only speak with the patient or the patient’s parent/legal guardian to schedule an appointment. This is due to HIPAA and also because it is critical to the therapy process that the patient be actively involved in their own treatment.

If you wish to continue with scheduling an appointment or testing services, please continue to the next page where you will complete the Online Patient Registration and History Form. It may take up to 45 minutes to complete depending on medical history. After submitting the form, you will receive a call from our office within 3-5 business days to schedule your appointment.

* If you are scheduling for any testing services, you ONLY need to complete the Demographics and Reason For Visit section of the form. If you are scheduling services for Medication Management or Therapy, you will need to complete the entire form before submission.