TX Frisco Behavioral Health Group Client Information 2019-2025 free printable template
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FRISCO BEHAVIORAL HEALTH GROUP, LLC Katelyn Breath, MS, LPC, NCC, LCD 4500 Hillcrest Road Suite 115 Frisco, Texas 75035 Tel. (469) 213.6400 Fax. (469) 213.6473CLIENT INFORMATION First NameMiddle Nameless
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How to fill out TX Frisco Behavioral Health Group Client Information
01
Start with the personal information section, filling in your full name.
02
Enter your date of birth in the specified format.
03
Fill in your contact details, including phone number and email address.
04
Provide your address, making sure to include city, state, and zip code.
05
Indicate your preferred method of contact (phone, email, etc.).
06
Complete the emergency contact section with a name and phone number.
07
Fill out the insurance information if applicable, including provider and policy number.
08
Answer any health history questions as accurately as possible.
09
Sign and date the form at the bottom.
Who needs TX Frisco Behavioral Health Group Client Information?
01
Individuals seeking mental health services at TX Frisco Behavioral Health Group.
02
Clients who are looking to initiate therapy or counseling sessions.
03
Anyone who requires evaluation or treatment within the facility.
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What is TX Frisco Behavioral Health Group Client Information?
TX Frisco Behavioral Health Group Client Information is a form that collects necessary personal and health-related data from clients seeking behavioral health services in Frisco, Texas.
Who is required to file TX Frisco Behavioral Health Group Client Information?
Clients who are seeking services from the TX Frisco Behavioral Health Group are required to file the Client Information.
How to fill out TX Frisco Behavioral Health Group Client Information?
To fill out TX Frisco Behavioral Health Group Client Information, clients should provide accurate personal details, including their name, contact information, insurance details, and relevant medical history as instructed on the form.
What is the purpose of TX Frisco Behavioral Health Group Client Information?
The purpose of TX Frisco Behavioral Health Group Client Information is to gather essential data to ensure appropriate care, treatment planning, and effective communication between the healthcare provider and the client.
What information must be reported on TX Frisco Behavioral Health Group Client Information?
Required information on TX Frisco Behavioral Health Group Client Information includes personal identification details, insurance information, medical history, behavioral health status, and emergency contact information.
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