Patient Registration

P.O. Box 78027
Charlotte, NC 28271

704.246.7175

[email protected]
[email protected]

Monday – Friday:
9am – 5pm

Telephone messages left after 5:00 pm or on the weekend will be returned the next business day.

*First Name

*Last Name

*Country

*Address

Suite/Apt Number

*City

*State

*ZipCode

*Phone

Fax

*Email Address (also will be your username)

*Practitioner (Need one? Use our Locator to find one.)

If other selected above, provide details on your practitioner below

*Password

*How Did You Hear About Us

*I have read and agree to the terms and conditions

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