Looking for assistance?

Let us know how we can help. After you complete the form one of our trusted care coordinators will be in touch within two business days.

Confidentiality - the information you provide to Included Health will remain confidential and is never shared with your employer.

Name *
Please enter the name you'd like us to call you. We do not require your legal name and will only ask for it if it's necessary for supporting a care request (such as booking an appointment for you!)
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This request is for...*


If you are looking for a provider, what kind of provider(s) would you like to see within the next 2-3 months?*


Please be as specific as possible. Tell us about you, the type of care you are looking for, the type of assistance you need, and any other important information.


How quickly are you looking for care or assistance?:*






Telehealth vs in-person preference:*
Given Covid-19, we want to understand your preferences. We understand some doctor appointments cannot be conducted via, Telehealth, so for those we will find in-person options.






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Insurance Carrier (e.g. Aetna, BCBS, Cigna, Kaiser, United, etc.)
Plan Type (e.g. EPO, HMO, POS, PPO, HDHP)


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Are there specific towns, parts of cities, neighborhoods, and/or a travel radius in miles or minutes that you want us to limit your search to?


What are your pronouns?*


As a member of the LGBTQ+ Community, please tell us how you identify.*
Please select all that apply


How would you describe yourself?*


How would you like us to contact you back?*




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By submitting this form you are consenting to disclosing your personal information for purposes of receiving our services. For more information, please read our Terms of Service, which can be found at the bottom of this page.