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SHAC Appointments

The SHAC Clinic operates on Wednesday nights with appointments only being made between 5:30 and 8 p.m. Fields marked with a red square are required.

La clínica de SHAC maneja solo los miércoles por la noche entre las horas de 5:30 y 8:00. Las partes marcadas con una casilla roja son requeridas.

First Name/Nombre (Required)

Last Name/Apellido (Required)

Gender/Género (Required)

Male/Hombre
Female/Mujer
Other/Otro

Date of Birth/Fecha de Nacimiento (Required)

/ /

Phone Number/Número de Teléfono (Required)

E-Mail Address/Correo Electrónico

Reason for Visit/Razón de Visita (Required)

Need Interpreter?/Necesita Intérprete (Required)

Yes/Sí
No

Are you a previous SHAC Patient?/ ¿Es paciente de CCHC?

Yes/Sí
No

Are you a Carrboro Community Health Center Patient? (Required)

Yes
No