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
Registration
Patient Intake
Intake Form
Get Started
Wilmington Mental Health offers easy access to registration forms and the patient portal, where you can view your next appointment date; send secure, non-urgent messages or questions to staff; view your personal health information including medications and lab results; view summaries from your medical appointments; and update your demographic information (i.e., address, phone, insurance).


You will receive information to create an account during your first contact.

Are you a new patient?

Access our Patient Registration Packet here.
Are you an existing patient?

Access our Patient Portal here.

We use registration forms to obtain core data and identify our patients. The forms help us better understand your situation and design a treatment that fits your needs. To save time when you arrive for your first appointment, please complete our intake packet. If you prefer, you can download and print the intake here. You must bring it with you during your first visit. If any information changes during your treatment, please let us know.

If you would like to establish yourself as a patient, please call our main office.

Primary Care and Behavioral Health:
New Hanover: (910) 777-5575
After hours:
If you feel that you are experiencing a true emergency, call 911. Wilmington Mental Health Crisis Line: 910-777-7712
Select a Form
Registration
Intake Packet
Authorization Form
Ingreso del Paciente
Planilla de Autorización
Medical Services
New Patient Health History Form (Coming Soon)
Consent Forms (Coming Soon)
Clinical Evaluations
Attention-Deficit/Hyperactivity
Bariatric Surgery
Drug and Alcohol Abuse
Immigration (Mental Health)
Adult Sex Offender
Domestic Violence
Anger Management
Professional Disclosure Statements
Joseph Rengifo
Havah Hanzler
Sarah Scott Ford
Sarah Mooring
Joanne Lee
Juliana Stanfield
Important Documents

The content and information you are releasing to us is protected under State and Federal law (45 CFR Part 164 and 164; 42 CFR Part 2) and cannot be re-disclosed without my further written consent as authorized by G.S. 122C-53 through G.S. 122C-56. The circumstances under which disclosure is permitted or required by state or federal confidentiality rules are described in our Notice of Privacy Practices.
Email/Texting Consent
We keep your Protected Health Information private and secure. This consent form is to gain permission to share administrative information like appointment reminders, scheduling, or payment receipts with you. Please understand that some potential risks associated with email/text interaction include: misdelivery, unauthorized access to thirdpartes, information may remain in the cloud. Please indicate your preferences about emails and texts and sign this form.
Download Form
Release of Information
This form is to give us permission to communicate with third parties. The content and information to be released is protected under State and Federal law (45 CFR Part 164 and 164; 42 CFR Part 2) and cannot be re-disclosed without further written consent as authorized by G.S. 122C-53 through G.S. 122C-56. A general authorization for the release of other medical information is not sufficient for this purpose. More details can be found in our Privacy Practice form.
Download Form
Payment Authorization

We ask you to provide formal authorization to process credit card payments. Please verify and complete this form to give Wilmington Mental Health to do so. Do not omit any fields and include your signature and today’s date at the end.

A picture ID (school ID, military ID, etc.) is required for all patients 18-year-old and older to protect you and our practice against insurance fraud.


Download Form
Artwork

HOMEWORK ASSINGMENTS
Therapy Worksheets

Homework is an element of therapy that makes it collaboratively and allow patients to rehearse skills learned during treatment. Our therapists assign tasks to be completed between sessions to:

Facilitate processing • Develop awareness • Promote active change • Consolidate learned knowledge • Foster long-lasting outcomes.

Personal Goals
Self-Care Activities
Sleep Hygiene
Breathing Retraining
Cognitive Distortions
Gratitude Journal
Who Am I?
Anger Management Skills
Miracle Question
Thought Record
SOLVED Technique
Assertive Communication
Active Listening
Relapse Prevention Plan
Couples Exercices