Online Pre-Intake Form
Horizon Treatment Center
24681 Northwestern Hwy Ste 306, Southfield, MI 48075-2302
248-423-1728 (Office) & 248-423-1734 (Fax)
Website created by Smith - contact webmaster@Horizontreatment.org for website issues.
Copyright © 2018 Horizon Treatment Center.  All Rights Reserved.
Welcome to our New Online Pre-Intake Form
C
omplete & submit. You will be contacted within 24 hours with your scheduled Intake appointment
Name:
Phone #
Birthdate
Copay $:
Your Insurance:
Services sought:
Past Therapy HX?
Suicidal/homicidal?
When would you like to schedule your Intake?
Questions, comments, or feedback: