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Services Across the Lifespan for Individuals with Autism Spectrum Disorder
“Greenville

Referral

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 appropriate age group and click 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 kathleen_holler@med.unc.edu  252-830-3300 ext. 222. 

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