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“Raleigh

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

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)

If you have any questions regarding the intake forms or the referral process
at the Raleigh TEACCH Center, please call 919-445-5793

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