Orientation On-line Registration Form

Sat. May 20th @ 1:15PM 

Sat. June 24th @ 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.

Please provide a phone number that we can reach you at in case the orientation is cancelled.

Please provide an e-mail address so we can send you information regarding the orientation you are registering for.

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!