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(480) 508-0882

Scottsdale  |  Tempe

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Scottsdale Mental Health and Wellness Institute
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PCP pre-registration Form

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NOTE: A photo ID must be uploaded with this form in order to process your registration. You may take a photo of your ID and other supporting documents, and upload as instructed below. If you have health insurance , please include photos of the front and back of the insurance card. You can upload these images utilizing this form or send them to PCAdmissions@smhwi.com once these steps are completed and the admissions representative will call you to schedule an appointment. When this form is completed 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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Max. file size: 256 MB.
Max. file size: 256 MB.
**( patients using insurance will need to provide insurance cards prior to getting on the schedule)*
This field is for validation purposes and should be left unchanged.

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Scottsdale

Tempe

TEL: (480) 508-0882

FAX: (480) 508-0891

EMAIL: admissions@smhwi.com

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