Carolina TotalCare

Patient Intake Form

Welcome to our online Patient Intake Form. The information you fill in will be sent directly to our office, speeding up your office visit and allowing us to better serve your healthcare needs. PLEASE DO NOT FILL OUT THE "REASON FOR VISIT" SECTION, YOU WILL BE PROVIDED A FORM AT THE OFFICE FOR THIS INFORMATION. (Simply, scroll to the bottom of this section and hit the Next Button.) Call our office at 704-784-4445 to schedule your new patient appointment if you have not already done so. Thank you! We look forward to seeing you!

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