HIPAA Information Forms will be submitted through a secure, encrypted connection. Your privacy is our first priority. Please allow a moment for the form to load. 5200 Park Rd. Suite 102C Charlotte, NC 28209(704) 850-6479 10130 Mallard Creek Rd. Suite 300 Charlotte NC, 28262 (704) 944-3532 118 E. Council St. Suite 6 Salisbury, NC 28144(704) 850-6479