Clinic Child Registration

Prior to scheduling your first service, please download the Registration Form via the button below. Once you have completed and signed the form, please return to this page and send it to us as an attachment via the submission form below. After we receive the form, our office will contact you to set up your service.

Download Child REgistration Form

Child Registration Submission Form

Please submit your Registration Form as an attachment here!

Once you have submitted this form, we will get back in touch with you to schedule your service.

Register your child

Parent or Guardian's First Name*

Parent or Guardian's Last Name*

Phone

Email*

What services are you requesting?

Attach Registration Form

Attachments (0)

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Phone: 984-289-3890

Email: Therapy@carolinaschoolservices.com

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