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These forms are only to be completed by established patients of connect. If you are a new patient interested in scheduling an appointment please click HERE.

New Patients Forms

Intake Packet

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Release of Information

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Child Developmental History 

Our North Carolina Campuses

Durham

1802 Martin Luther King Pkwy. Ste. 107

Durham, NC 27707

Elizabeth City

511 S. McMorrine St. Ste. D

Elizabeth City, NC 27909

Charlotte

307 W. Tremont Ave. Ste. 200

Charlotte, NC 28203

Sanford

136 Carbonation Rd. Sanford, NC 27330

919.908.9308 (o) ~ 919.287.2206 (f)

© 2020 connect. Center for Wellness, PLLC    

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