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Provider Waitlist
We’re currently building our provider network in preparation for our launch between January–April 2027.
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Provider Type
*
(e.g., Therapist, Psychiatrist, Nurse Practitioner, etc.)
Specialty / Areas of Focus
*
License Type
*
Licensed State(s)
*
Which of the following best describes your current professional setting?
*
Please Select one
I run my own private practice
I’m part of a group practice
I work for a clinic or organization
I’m employed but planning to start my own practice
Other (please specify)
Other:
How do you currently provide care?
*
Please Select one
Telehealth only
In-person only
Hybrid (both)
Practice Name
*
Practice Website
*
Practice ZIP Code
*
How did you hear about us?
*
Please Select one
Google or another internet search
Event
Instagram
TikTok
LinkedIn
Word of Mouth
Other (Please specify)
Other:
How interested are you in joining RiseCare?
*
Please Select one
Sign me up!
I still have questions
Do you give RiseCare permission to contact you via email and/or phone? By joining our waitlist, you’re expressing interest in partnering with RiseCare. Based on the information you provide, a member of our leadership team may reach out to share next steps and schedule a brief introductory call to learn more about your practice and answer any questions.
*
Yes
No
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