Intake forms are required before your first appointment is scheduled.
You will be able to sent a copy of the form to yourself when complete it.
Please upload your ID and insurance card with the intake packet
* Click Intake package to complete
if your primary insurance is not Medicaid (private insurance, or Medicare)
** Click Intake package for clients with Medicaid and complete
If you have a NC Medicaid plan (Alliance, Carolina Complete Health, United Healthcare Medicaid, Amerithealth, Trillium, Vaya, Healthy Blue, or Healthy Blue Care together.
Symptom Scales
Parent/Guardian scale for children ages 6-17
Children scale for children self-report ages 11-17
Patient Health Questionnaire 9 (PHQ-9)
Life Events Checklist/PTSD Checklist-5 (LEC/PCL-5)
Other forms
Card Payment Consent Form (pdf fillable form)
Authorization for Release Of Information form (pdf fillable form)
If you have any questions feel free to call us at 910-249-4219 or 910-292-6597