Radical Healing Collaborative Appointment Request Form - Therapy

Please read before completing form:

  • We will do our best to match you with a therapist who aligns with your preferences. 

  • We are only able to offer weekly appointments at this time. Sessions may be moved to biweekly at the discretion of the therapist once care is established.

  • Our clinicians do not offer weekend appointments.

  • Our therapists are only available to provide care for clients who are residing in North Carolina due to state licensure restrictions. 

  • Many of our clinicians have waitlists for new insurance and self-pay patients. 

  • We accept Aetna, Cigna, United Healthcare, and all BCBS plans except Blue Value, Blue Local, and Blue Home. We do not accept Medicaid or Medicare.

  • If you are seeking psychological testing or a clinical assessment, please note that these services are often not covered by insurance; out-of-pocket costs range from $1,500 - $5,500.

If you or someone you know is experiencing mental health emergency, please consider using any of the below crisis resources:


  • The Trans Lifeline at 877-565-8860

  • Blackline at 800-604-5841 (prioritizes BIPOC callers)

  • The Samaritans Hotline at 877-870-4673

  • The National Domestic Violence Hotline at 800-799-7233

In-Person Crisis Resources:

  • Your nearest emergency room, or any of the below:

  • Carolina Outreach Behavioral Health Urgent Care 919-251-9009 (Durham County)

  • Durham Recovery Response Center 919-510-9132

  • Triangle Springs 919-372-4318 (Raleigh/Durham)

  • Pasadena Villa 877-845-5235 (Raleigh/Charlotte)

  • Wake County Crisis Stabilization Center 984-974-4800 (Wake County)

  • Holly Hill Respond 919-250-7000 (Wake County)

Please complete the following section for yourself or if you are a legal guardian, your dependent minor.

Insurance and Payment Information