Charles K. Burnett, Ph.D., Dr.P.H.

105 S. 4th Street Mebane, NC  27302 Phone:  (919) 563-2140

Licensed Psychologist

New Patient Forms


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.