New Patient Request Form

We appreciate your interest in Second Wind Mental Health and would like to provide you with some important information regarding our services. Before you proceed with completing the New Patient Inquiry Form, please take note of the following points:
  1. Insurance Coverage: Our clinic participates with Medicare, Medicare Managed Plans, Medicaid, and most Commercial Insurances. It’s important to be aware that not all of our therapists are in-network with the same insurance companies. For details about which specific providers we work with, please refer to our Insurance page.
  2. Billing and Out-of-Network Insurance: While we do bill insurance companies when our providers are in-network, we do not currently bill out-of-network insurance companies. However, we are more than happy to provide you with a bill that you can directly submit to your insurance company for potential reimbursement.
  3. Provider Availability: Many of our clinicians work full-time in the office. However, openings and placement within their schedule vary.
  4. Response Time: Once we receive your information via the form below, we will promptly review it and strive to get back to you as soon as possible. If you are in immediate need of services or are in crisis, please contact the Douglas County Crisis Hotline at 1-800-866-9780
Please go ahead and complete the form below. The information you provide will help us better understand your mental health needs, and we will be in touch to schedule an appointment based on the information you provide.
Please understand that due to practitioner availability, the nature of your clinical needs, and other factors, we may not always be able to accept every individual seeking services. We apologize in advance for any inconvenience this may cause.
We appreciate your interest in our clinic and look forward to the opportunity to assist you. After you submit the form, we will review the information and contact you. Thank you for considering our services.
Warm regards,
Second Wind Mental Health Clinic