Orientation On-line Registration Form

Sat. Novemebr 18th @ 1:15PM (FULL)

Sat. Decemebr 9th @ 1:15PM 

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 at in case the Orientation is cancelled.

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

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.

We appreciate your feedback!