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Please complete the following information to request an appointment to begin the Rice Diet Clinic in Durham, North Carolina. We will try our best to accommodate your date request.
We recommend an initial stay of at least four weeks, but shorter stays are possible. Once we receive this online form, we will contact you and then provide you some lodging options. If you have additional questions or would prefer to register via phone, please call us at (919) 383-7276, when the recording comes on, press 1 for the medical clinic.
If you have already spoken with Jayne Charles, our Program Coordinator, it is NOT necessary to complete this online registration.
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Are you a Returning Patient?
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Preferred Starting Date for Program:
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Day* |
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Year* |
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GENERAL INFORMATION


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| Date of Birth |
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