Join the Access Healthcare Direct Network
Please fill out the form below to join the network.  We will review the information and typically upload you to the Provider Directory and Employer Platforms within 1 week if you are approved.
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Email *
What is your NPI number? (credential verification only)
What is your Medical License Number and State ?
Provider name & Practice name *
Practice Phone & Address *
Practice Website *
Email Address *
Do you want to join the Access Healthcare Direct Network of Direct Primary Care Practices? *
 Would you like us to market to employers and patients on your behalf through our phone apps and DPC Doctor finder,  the Accresa platform, GoMD/FlexPerx and our website. *
What is the minimum monthly fee you will accept per person for Direct Employer Contracts?  (You can charge any amount you like but Employers frequently search for practices based on  this filter)
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Are you a Direct Primary Care practice by the current accepted definition and not planning on billing any insurance companies or Medicare? *
Are you currently Board Certified or Eligible?
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Have you ever had a malpractice claim? *
Please indicate in this box common services that you include in your DPC membership at no additional charge (office visits, physicals, common labs etc)
How much capacity do you have for new patients?
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What is the average monthly fee you will be charging?
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Do you agree to the terms and policies below: If so type your name here to sign electronically *
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