• Please complete the following form to notify us about your need for treatment. Appointments are not provided until this form is completed and we are able to create a patient record in our electronic health system. We require copies of your insurance card front and back and a copy of your license to verify your identity. You can upload these images utilizing this form or send them to admissions@smhwi.com. Once these steps are completed an admissions representative will call you to schedule an appointment. When you complete this pre-registration form an email will be sent to you with instructions on how to set up your patient portal and how to complete your intake forms. Thank you!
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