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  • Tx Frisco Behavioral Health Group Client Information 2019

Get Tx Frisco Behavioral Health Group Client Information 2019-2025

E Last Name Street Address Birthdate / City State Cell Phone Email address Male Female Sex Age / Zip Code Home Phone Okay to leave voice mail Yes No IN CASE OF EMERGENCY Emergency Contact: Relationship to Client: Emergency Contact Number: Do we have permission to contact them regarding your appointments, billing or in case of emergency? Yes No THE FOLLOWING INFORMATION MUST BE COMPLETED CLIENT INSURER / RESPONSIBLE PARTY Name: Name: Employer: E.

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How to fill out the TX Frisco Behavioral Health Group Client Information online

Filling out the TX Frisco Behavioral Health Group Client Information form online is an important step in accessing mental health services. This guide provides clear and supportive instructions to help you complete each section of the form with confidence and ease.

Follow the steps to successfully complete the client information form

  1. Press the ‘Get Form’ button to retrieve the client information form and access it in a suitable editor.
  2. Enter your first name, middle name (if applicable), and last name in the designated fields.
  3. Fill in your street address, including city, state, and zip code for accurate identification.
  4. Specify your birthdate using the provided format to ensure proper age verification.
  5. List your cell phone number and home phone number, indicating which number is okay for voicemail.
  6. Select your sex from the options provided by checking the appropriate box.
  7. Indicate your age in the specified field to support demographic data collection.
  8. In the emergency contact section, provide the name, relationship to you, and a contact number of your emergency contact.
  9. Specify whether permission is granted for the office to contact your emergency contact regarding appointments or billing by selecting yes or no.
  10. Complete the insurer/responsible party section with the necessary details, including their name, employer, and contact information.
  11. Indicate who referred you to the Frisco Behavioral Health Group, if applicable.
  12. List any current medications, including dosage and the prescribing physician's name.
  13. Briefly state the reason for your visit in the text box provided.
  14. Review all provided information for accuracy before submitting the form.
  15. Once completed, save any changes made, and choose to download, print, or share the form as needed.

Complete your documents online today to ensure a smooth experience.

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Contact support

We employ more than 1,800 behavioral health workers including psychiatrists, psychologists, and medical doctors, social workers, nurses, rehab therapists, counselors, teachers, aides, and a range of paraprofessional staff.

Stars Company Profile We employ more than 1,800 behavioral health workers including psychiatrists, psychologists, and medical doctors, social workers, nurses, rehab therapists, counselors, teachers, aides, and a range of paraprofessional staff.

360 Behavioral Health has 1,001 to 5,000 employees.

Behavioral Health Group's revenue is $270.0 million. Behavioral Health Group's annual revenue is $270.0M. Zippia's data science team found the following key financial metrics about Behavioral Health Group after extensive research and analysis. Behavioral Health Group peak revenue was $270.0M in 2023.

Kent Dunlap, MPH, President and Chief Executive Officer, has over 30 years experience in developing and managing social services and health care facilities, programs, and systems. Mr. Dunlap specializes in strategic planning, contracting, government relations, as well as operations management.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232