To request an appointment at the Charlotte TEACCH Center, please complete the appropriate forms. Once the completed forms and requested reports are received by the Charlotte TEACCH Center, you will be contacted to schedule an appointment.

Choose appropriate age group and click button for Referral Process and Forms:

REFERRAL PROCESS and FORMS for Children and Adolescents
(through age 17)

REFERRAL PROCESS and FORMS for Adult Client
(age 18 and older who is NOT his/her OWN GUARDIAN)

REFERRAL PROCESS and FORMS for Adult Client
(age 18 and older who is his/her OWN GUARDIAN)

If you have any questions regarding the intake forms or the referral process
at the
Charlotte TEACCH Center call 704-563-4103

UNC Health Care Forms
To read Notice of Privacy Practice – English | Spanish
General Consent for Treatment – English | Spanish
UNC Patient Rights – English | Spanish
Release of Medical Information and Confidentiality Authorization Form – English | Spanish