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Hayley Ne meth, LCSW, LLC Intake Questionnaire Demographic Information Name: DOB: Gender Identity: Male Female Other Age: Legal Guardian Name (if applicable): Address: City: State: Zip Preferred Phone

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What is hayley nemeth lcswhorizon wellness?

Hayley Nemeth LCSW Horizon Wellness is a mental health service provider.

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Patients or clients who have received services from Hayley Nemeth LCSW Horizon Wellness may be required to file for insurance reimbursement or keep records for their personal use.

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To fill out the forms for Hayley Nemeth LCSW Horizon Wellness, patients or clients need to provide personal information, reason for visit, current mental health status, and insurance details if applicable.

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The purpose of Hayley Nemeth LCSW Horizon Wellness is to provide mental health services and support to individuals in need.

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Information such as personal details, mental health history, insurance information, and reason for visit must be reported on Hayley Nemeth LCSW Horizon Wellness forms.