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

Program Effective Date *
Program Effective Date
Is this an ACP client? *
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)
Plan Design (Session Model) *
(if applicable)
Does the company have a UR vendor? If so, who is the provider?
Does the company provide mental health and substance abuse (MHSA) benefits? If so, what is the company's MHSA network(s)?

Note: In addition to short-term counseling, all Allied Care Solutions Behavioral 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.