Our emergency line, (336)-525-9090, is staffed 24/7 for current clients.

Complete before your visit. Or use printable version.

To complete before medication visits.

To complete before medication visits.

Agreement to therapy/counseling through telehealth

Let us know how we can improve our services.

Request disability or FMLA forms.

For clients who need us to provide testimony or consultation for legal purposes.

Authorize us to communicate with your family or friends.

Release or records to other parties.