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

Referral

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

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)

If you have any questions regarding the intake forms or the referral process at the Wilmington TEACCH Center,
please call our Resource & Referral Specialist at  919-445-0679

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