(855) 875-5812 Menu

Charlotte Appointments

Intake forms for Veritas Collaborative in Charlotte, NC

In order to assess if Veritas Collaborative in Charlotte is an appropriate fit for you, your loved one, or your patient, we need to collect necessary clinical and medical information. The more details we have, the better we can assist you. Please take a moment to complete the forms below.

Preliminary Assessment (Charlotte)

Program Evaluation for All Patients

View & Submit

Release of Information

Please submit one form for each healthcare provider. If you are 18 years or older and would like a parent or family member involved in treatment, please submit a release form for that person.

View & Submit