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For Individuals

Fill out the form below and we’ll contact you about becoming an Unorthodoc patient.

Patient Interest Form

Because we give generous time and attention to our patients, we intermittently have a wait list. If you are interested in becoming a patient, fill out the short form below. We will contact you with current appointment availability. Reading the FAQ section on our website provides answers to common questions. This is a simple information form that comes to us through standard email. Therefore, THIS FORM IS NOT HIPAA-COMPLIANT. Be cautious about what you share. Call 919-914-9611 and leave a confidential voicemail if you need to provide more sensitive information.
Name(Required)
Preferred Contact Method
Do you have an HMO insurance plan?
Check your insurance card to see if it says "HMO" anywhere. Common examples of HMO plans include many Medicare Advantage Plans, including United Health Medicare Advantage HMO. If you have an HMO plan this year, it will not pair well with Unorthodoc. We urge you to change your insurance when you can and delay your Direct Primary Care membership. If you say "Yes" to this question, we will discuss it with you further before authorizing your membership with our practice.
Are you considering an individual membership or a family membership?(Required)
Do you have a physician preference?(Required)
Do you have a clinic location preference?(Required)
How did you hear about Unorthodoc?
Check all that apply
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Please note

Because we give generous time and attention to our patients, we intermittently have a wait list. If you are interested in becoming a patient, fill out the short form on this page. We will contact you with current appointment availability.

Reading the FAQ page on our website provides answers to common questions. This is a simple information form that comes to us through standard email. Therefore, THIS FORM IS NOT HIPAA-COMPLIANT. Be cautious about what you share. Call 919-914-9611 and leave a confidential voicemail if you need to provide more sensitive information.