Phone 541-679-0366 l 541-679-4821 Fax

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  • Providers
    • Tamara Lee
    • Jenny Tausch
    • Michael Smith-Fernandez
    • Lisa Jennings
    • McKenzie Smith
    • Andrea Witham
    • Ann Carey
  • Becoming a Patient
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  • More
    • Home
    • Providers
      • Tamara Lee
      • Jenny Tausch
      • Michael Smith-Fernandez
      • Lisa Jennings
      • McKenzie Smith
      • Andrea Witham
      • Ann Carey
    • Becoming a Patient
    • ...
  • Home
  • Providers
    • Tamara Lee
    • Jenny Tausch
    • Michael Smith-Fernandez
    • Lisa Jennings
    • McKenzie Smith
    • Andrea Witham
    • Ann Carey
  • Becoming a Patient
  • ...

Application

 To complete the application download the PDF below. 

We have both Adult and Adolescent applications


Please make sure all information on the patient information page is complete and accurate, including insurance and phone numbers. 



Please pick which application applies to the patient.

Please note you will need to have Adobe Acrobat downloaded to be able to fill out applications electronically. 

Application-Adult & Youth ages 14 & up (pdf)Download
Application-Adolescent ages 5-13 (pdf)Download

Choose a method below to return the Application.

Mail

Second Wind Mental Health

11 SW Brantley Dr.

Winston, OR 97496

Fax

541-679-4821

Email

Staff@secondwindmentalhealth.com

After Submitting An Application

Once your application has reached our New Patient Coordinator it usually take between 1-2 weeks for a response. Each application is approved by the owner of Second Wind Mental Health. Once approved the application will be assigned for individual providers for approval. When this is done then we will call to set up an appointment if you have been accepted.  If we are not able to take you on as a patient we will inform you as soon as possible. Thank you for understanding .               ~Second Wind Staff~                                  


  • Becoming a Patient

Second Wind Mental Health

11 SW Brantley DR, Winston, OR 97496, US

Phone 541-679-0366 l 541-679-4821 Fax

Staff@secondwindmentalhealth.com

Copyright © 2018 Second Wind Mental Health, LLC - All Rights Reserved.

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