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Forms

Download and Print Center

New Patients:
click on links below to download, print and complete REQUIRED FORMS

Spinal Disc AND/OR Neuropathy Patients Click HERE for Intake Form (required)
Spinal Disc AND/OR Neuropathy Patients Click HERE for HIPAA Form (required)
All Patients Click HERE for HIPAA Booklet (not required)

Contact our Office to Schedule a Consultation
704-541-5555



Select Health of the Carolinas
15830 Ballantyne Medical Place
Suite #250
Charlotte, NC 28277
704-541-5555



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