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Participant Referral Form - Signing a Contract
ABOUT

REFERRAL FORM

PATIENT DEMOGRAPHICS
Guardianship?
Select an option
Select an option
Potential Transportation Issue?
Does the patient have a current mental health provider?

Thanks for submitting!

> Refer A Patient Or Loved One

SERVICES

Amara Wellness Services Logo
AWS Cares Logo

Office Hours - Modified Due to COVID-19

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Monday - Thursday: 

8:30am - 5:00pm 

Friday:  8:30am - 1:00pm

Saturday: By Appointment Only

 

Address:

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5108 Reagan Drive, Suite 9

Charlotte, NC 28206

AWS Cares - CARF Accreditation

Phone numbers:

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Office Number: (704) 567-0790

Medical Records Fax: (833) 834-2555

Nursing Fax Line: (833) 729-2811

Referral Fax Line: (833) 729-2812

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CONTACT US  & SCHEDULE AN APPOINTMENT

Thanks for submitting!

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