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

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    • McKenzie Smith
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      • Tamara Lee
      • Jenny Tausch
      • Michael Smith-Fernandez
      • Diane Rose
      • Thomas Pugel
      • McKenzie Smith
    • Becoming a Patient
    • ...
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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.

Application - Adult (pdf)Download
Application-Adolescent (pdf)Download

Choose a method below to return the Application.

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Mail

Second Wind Mental Health

11 SW Brantley Dr.

Winston, OR 97496

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Fax

541-679-4821

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Email

Staff@secondwindmentalhealth.com

  • 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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