Primary Care, Psychiatry, Physical Therapy, and Other Medical Care Appointment Request Form

Radical Healing is excited to add more inclusive medical care providers. Appointments are available now for in person appointments in Durham or virtual telehealth appointments for residents across the entire state of North Carolina (and psychiatry in Florida!).  To begin the onboarding process with us, please complete the following form. Someone will be in touch with you within a few days to set up your initial appointment and intake paperwork. To follow up or request more information, please call our main line at 919-341-6111.


Note: We are currently onboarding those with Blue Cross Blue Shield (including Healthy Blue but excluding Blue Local, Blue Value and Blue Home), Aetna, United Healthcare (including the Community Plan), Tricare, Medcost, and Cigna insurance plans, and those who wish to be self-pay. We are also in network with the following Medicaid Plans: BCBS/Healthy Blue, United Community Plan, Wellcare, Amerihealth, Ambetter. (Updated 7/23/2025)

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

Insurance and Payment Information

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