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

Program Effective Date *
Program Effective Date
Client Address
Client Address
Client Contact Name
Client Contact Name
Client Contact Phone Number
Client Contact Phone Number
AmeraPlan Contact Name *
AmeraPlan Contact Name
AmeraPlan Contact Phone Number
AmeraPlan Contact Phone Number
(if applicable)
Plan Design (Session Model) *
Does the company have a UR vendor? If so, who is the provider?
Does the company have a disease management vendor? If so, who is the vendor?
Does the company administer a health risk assessment test? 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 AmeraPlan 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.