Make an Appointment

Please fill out this form to make an appointment at the SHAC Medical Clinic. The Clinic operates on Wednesday nights with appointments starting at 6PM.

**** NOTE: Please visit the Dental SHAC page for more information about accessing dental services.
DENTAL APPOINTMENTS CANNOT BE MADE USING THE FORM ON THIS PAGE.

Fields marked with a red square are required.

En español:

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.

Gender/Género  



Date of Birth/Fecha de Nacimiento  
/ /   :
Need Interpreter?/Necesita Intérprete  


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


Are you a Carrboro Community Health Center Patient?