Below are copies of forms that Dr. Hendricks uses in his practice.
- The first is an intake form, which allows Dr. Hendricks to gather some basic administrative and clinical information about you. Please complete this form prior to your first appointment. To complete the form, you may either download it on your computer and fill in the information using the Adobe “add text” feature or print it out and complete it by hand. In either case, please either email this to mhendricksphd@gmail.com in advance of your first appointment or bring a printed copy with you to the appointment.
- The second is an Agreement for Services that spells out some of the expectations of the professional relationship, as well as the legal limits to confidentiality. You do not need to download this and print it out. Dr. Hendricks will have a copy ready for you. This electronic version is provided for your reference. Please read it before coming to your first appointment, as you will need to sign this at that time.
- The third is a statement of your privacy rights under HIPAA. This document is provided for your information. It does not require your signature, but you are encouraged to read it, especially if you have not read any other provider’s HIPAA rights statement.