Wayfinder Behavioral Health Client/Family Pre-Screen Form

Many of our prospective clients and/or loved ones find it helpful to provide background information before or in addition to contacting Wayfinder directly. Once submitted, your answers will go directly to a member of our Admissions team. Please allow up to 24 hours for response time. Thank you and we look forward to getting in touch!

Name

First Name

Last Name

Email

I am inquiring about services for:

Full name of person seeking services

First Name

Last Name

Date of birth of person seeking services (if known)

MM

DD

YYYY

Health insurance plan of person seeking services (if known)

Contact Us