Adult Intake Form - Horizons Counseling ServicesAdult Intake Form • September 8th, 2021
(see Services and Fee Agreement for limits of confidentiality for email and text messages) Birth date: Age: Social Security Number: Employer:
Adult Intake Form - Horizons Counseling ServicesAdult Intake Form • January 16th, 2023
(see Services and Fee Agreement for limits of confidentiality for email and text messages) Birth date: Age: Social Security Number: Employer:
