Please complete the form below to notify CuraLinc Healthcare of a new Allied Care Solutions Wellness client. Your CuraLinc Client Relationship Manager will send a confirmation of receipt within two business days.

Program Effective Date *
Program Effective Date
Allied Contact Name *
Allied Contact Name
Allied Contact Phone Number
Allied Contact Phone Number
Client Contact Name
Client Contact Name
Client Contact Phone Number
Client Contact Phone Number
(if applicable)
ACS Wellness Plan Design
(choose all that apply)
Note: A CuraLinc Healthcare representative will contact you regarding options (B) and/or (C), if either box is checked.
Does Company have a Disease Management Program? If yes, who is the vendor?
Does Company administer a Health Risk Assessment Questionnaire (from a different vendor)? If yes, who is the vendor?
Does Company have Allied Care Solutions Behavioral?
Does the wellness program contain an incentive for employees to call a Health Coach?
Note: If this answer is 'yes', please make sure the program is priced appropriately. Wellness plans that provide members with an incentive for calling a health coach cost more than the Core ACS Wellness program. Contact Mindee Zis for details.
Is there an incentive for employees to take Biometric Screenings?
(if applicable)

Note: In addition to short-term counseling, all Allied Care Solutions Wellness models include free legal and financial consultation, expert dependent care referrals, organizational consultation, video counseling and a technology suite (web platform and mobile app) that can be tailored at a group, client or partner level. All programs also include access to worksite service components, such as critical incident response services and training.