Orientation On-line Registration Form

August 10th (Sat.) 1:30PM -3:30PM

August 17th  (Sat.) 3:00PM WILMINGTON OFFICE

Sept. 7th (Sat.) 1:30PM -3:30PM

Intro to the Carolina Center: Prospective & New Patient Orientation

Please fill out the form below to register for an Orientation and click on the SUBMIT button. A confirmation message will appear on the page if your registration was successfully submitted.

Please provide a phone number that we can reach you if the Orientation is cancelled.

You will receive an e-mail reminder a few days prior to Orientation.

Enter the city where you currently live

Please select your patient status below

Only New Patients (Incoming) are permitted to bring ONE guest with them. Otherwise each person must register separately.

The information you provide will help us for staffing purposes.

You may check more than one box

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