Referral | TEACCH® Autism Program

To initiate services at the Greenville TEACCH® Center, please complete the appropriate intake forms. Once the completed intake forms are received by the Greenville TEACCH Center, you will be contacted by our Resource and Referral Specialist to discuss next steps.

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

REFERRAL FORMS for Children and Adolescents
(through age 17)

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

REFERRAL 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 Greenville TEACCH Center, contact katie_fox@med.unc.edu at 919-966-0212

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