This application is the best way we can decide how to provide you care and who is the best provider for you. Applying is not a guarantee that the applicant will become a patient of one of the providers. If you have any further questions please feel free to contact us.
If you are interested in becoming a patient of one of our providers please click on the application button below fill out the application and resubmit it for review. We currently only treat adults 14 and over.
Our application may be filled out online and emailed back to us at the following:
(Please note there is no guarantee your information will remain confidential over the internet)
Our application may be filled out online printed and faxed back to us at the following:
Mailed or Dropped off:
Our application may be filled out online printed and mailed back or dropped off to us at the following:
Second Wind Mental Health
11 SW Brantley Dr. Winston, OR 97496
Contact Us for office hours, and more directions as our address and location can be confusing to find.