Visit us Mon-Fri from 9:00am to 6:30pm
 3825 Market St, Suite 4
 info@wmhwc.com
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Pre-Registration
Patient Portal

Call or Text: 910.777.5575

Appointment Request
ONLINE FORMS

New Patient Registration

Registration is required for all services we offer. We recommend that you call ahead to schedule an appointment and have a valid identification, a copy of your insurance card(s) and, if necessary, any documents from your previous treatment(s) with you during your first visit. We also recommend that you arrive at least 30 minutes prior to your appointment to complete the paperwork and have a list of any medications you may be taking.
NEW PATIENTS
Patient Registration Form (Intake Packet)
Patient Psychiatry History
Patient Health History
Fillable Intake Packet: Download Pdf File here.
EXISTING PATIENTS
Patient Portal
Medical Records Release Form (Records From WMH)
Medical Records Request Form (Records From Third Party)
Credit Card Authorization Form
If you would like to be established as a patient, please call our office.
We like to identify our patients and obtain core data that helps us better understand their situation. The information not only helps our providers design a treatment that fits their patient’s needs, but also protect our patients from fraud.
To save time, we ask our patients to complete our intake packet online or download the printable version and bring it with them to their first appointments. When completing the form online, please fill out all necessary fields and do not forget to click submit at the end. The form will automatically be sent to us.
All of our forms and encrypted to protect the safety of our patient’s information. The security and privacy of your personal data is our main concern and we take every precaution to protect it.
Therapist talking to a patient about workers' comp mental health therapy.
If you choose to send us a hard copy of the registration form by mail, please attach a copy of your identification and insurance card (back and front). If any information about you changes during your treatment, please let us know.
In-Network Insurances
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Financial Policy
Privacy Policy
We ask to verify your contact information and insurance coverage every visit to ensure that your information is up to date.