Contact Us

Carolina Parenting Solutions PLLC

Who is the Policy Holder/Grantor on the insurance plan?

Tell us what brings you to us. Please include concerns that you are having with your child and little bit about what's been happening. *

Zip Code *

Your child's name *

Address *

**Certified secure https site**

Policy Holder's Date of Birth?

Where does your child attend school?

Is there anything else you'd like to share about your child or family?

Phone *

Name: *

What is the Member ID/Subscriber ID on your child's insurance card?

Are there other providers working with your child?

* Meetings By Appointment Only *

Who is your child's Pediatrician Group?

Is there flexibility in your scheduling needs to be seen during day time hours if planned ahead of time?

Highest Quality Services Made Affordable

Who can we thank for referring you to us?

What is the Group # on the insurance plan?

Your child's date of birth *

Please name of SPECIFIC DOCTOR in Practice

What type of insurance coverage/plan does your child have?

Online Intake Registration Form

Email: *

Check here to receive email updates

What is your availability to be seen by a therapist in your home with your child? **Be as specific as you can for when you can be seen on a regular weekly basis for sessions (sessions generally last 45-50 and are weekly.) *

Our Service Area includes :
Greater Charlotte, NC,

Huntersville/Mooresville/Cornelius, NC
Cabarrus County, NC
Union County, NC
Fort Mill, SC and Rock Hill, SC
(*depending on therapist availability, client location and your availability to be seen in your home with your child.)

Yes! I want to apply for services, so "Let's Get Started" by completing the online registration form below and submitting it. We'll be working in the background to evaluate your needs, make sure we are the right services for you and see what availability we have to offer your child and family to get started with services.

Policy Holder/Grantor's Place of Work?

Apply for Services Now

with the

Online Intake Registration Form below