WELCOME TO WIN HEALTH!
To get started, please hit 'Next' and fill out all of the required information.
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CLIENT SIGN UP INFORMATION
Please fill out all the required information and hit 'Next' when complete.
FULL NAME
*
First Name
Last Name
PHONE NUMBER
*
Please enter a valid phone number.
EMAIL
*
example@example.com
IS IT OKAY TO SEND MESSAGES TO THIS EMAIL
YES
NO
IS IT OKAY TO SEND APPOINTMENT REMINDERS TO THIS EMAIL
YES
NO
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
DATE OF BIRTH
*
-
Month
-
Day
Year
Date
GENDER
*
FEMALE
MALE
OTHER
CLIENT TYPE
*
ADULT
MINOR
PLEASE SELECT YOUR REQUESTED CLINICIAN (REMEMBER TO PLEASE CHOOSE THE CLINICIAN THAT IS WITHIN YOUR STATE)
Please Select
KRIS SHEHU (MICHIGAN)
CHRISTINA HOPKINS BRACKETT (MICHIGAN)
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THANK YOU FOR SIGNING UP TO WIN HEALTH!
Once when you hit 'Submit' you will be redirected to the log in portal. It may take a moment for your information to upload to our system. Please be patient while this is processing.
SUBMIT
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