Would You Like to hear From us?

Would you like to hear from us?

Please complete the information below so that we may better serve you. (Your e-mail address is the only required information on this page.) We will have a representative contact you.

What type of facility are you associated with?

School

Assisted Living/Rest Home
Nursing/Skilled Nursing
Other

How are mental health needs addressed at this time?

No formal plan
Local mental health center
On-site provider

How many individuals are cared for at this location?

Under 60
61-100
101 +

Are you pleased with your current service provision?

I do not feel current services make a difference
There is room for improvement
I am extremely satisfied with our care provider

Comments:

Name:
E-mail Address: Required
Address:
City:
State:
Zip Code:
Phone Number:

ACT Medical Group, PA
Corporate Office
311-4E Judges Rd.
Wilmington, NC 28405

Phone:
910-791-6767
Toll-Free:
888-311-1254
Fax:
910-791-6890
Email:
Administration

Employees Only-Intranet