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These forms are only to be completed by established patients of connect. If you are a new patient interested in scheduling an appointment please click HERE.

New Patients Forms

Intake Packet

Release of Information

Child Developmental History 

Our North Carolina Campuses

Durham

1802 Martin Luther King Pkwy. Ste. 107

Durham, NC 27707

Elizabeth City

511 S. McMorrine St. Ste. D

Elizabeth City, NC 27909

Charlotte

228 Westinghouse Blvd. Ste. 111

Charlotte, NC 28273

919.908.9308 (o) ~ 919.287.2206 (f)

© 2020 connect. Center for Wellness, PLLC    

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