General Inquiry Form

Use the form on the right to contact us. This form will allow you to send a general inquiry to Carolina Performance. We will do our best to respond to you within two business days.

To contact any of the individual practitioners at Carolina Performance directly, click on CONTACT US or the tab above.

You may also contact us via phone at 1.888.676.9699 or 919.676.9699.

Note: Your email address is not logged by this system, but will be attached to the message that is forwarded from this page.

Name *
Name

8300 Health Park Suite 201
Raleigh NC 27615
USA

919.676.9699

At Carolina Performance, our providers treat regular people like you for mental health concerns. Most of our clients are non-athletes. Our mission is to enhance the performance of our clients, resulting in a smarter approach to sport, a more effective work life, and an improved general well-being. We use mental training techniques to build upon existing skills, develop mental game plans, achieve individual and team goals, and maximize potential.

Intake Forms

At Carolina Performance, our providers are in solo private practice and require their own individualized intake forms that are necessary for your first appointment.

 

Intake Forms

 

Please download and print the intake form that corresponds to your provider. Please bring completed contact information and signed consent forms to your first appointment. The remaining pages are for you to keep for your records. Feel free to contact us if you have any questions about filling out the forms.

 

Dr. Eric Morse
Click here to download Intake Form (.pdf)

Dr. Joshua Dittmer
Click here to download Intake Form (.pdf)

Dr. Jun He
Click here to download Intake Form (.pdf) 

Dr. Hima Palakurthi
Click here to download Intake Form (.pdf) 

Dr. Heidi Green
Click here to download Intake Form (.pdf)

Dr. Matther Bader
Click here to download Intake Form (.pdf)

Dr. Kyle Savage
Click here to download Intake Form (.pdf)

 

 

 

 
 

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8300 Health Park Suite 201 • Raleigh NC 27615 • 1.888.676.9699 or 919.676.9699 • info@carolinaperformance.net
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