Charles K. Burnett, Ph.D., Dr.P.H.
105 S. 4th Street Mebane, NC 27302 Phone: (919) 563-2140
Click here to download the Patient Demographics Form.Click here to download the New Patient Questionnaire.Click here to download a Release of Information Form.Click here to dowload the Patient Agreement Form.Click here to dowload the HIPAA Privacy Notice.
Content copyright 2015. Charles K. Burnett, Ph.D., Dr.P.H. All rights reserved.