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

Program Effective Date *
Program Effective Date
Client Contact Address
Client Contact Address
Client Contact Name
Client Contact Name
Client Contact Phone Number
Client Contact Phone Number
BAS Contact Name *
BAS Contact Name
BAS Contact Phone Number
BAS Contact Phone Number
(if applicable)
Client Broker Phone Number
Client Broker Phone Number
(choose one)
(if applicable)
Is Company a BAS Health Portfolio client?
Does this group have BAS Wellbeing?
Does the company have a UR vendor? If so, who is the provider?
Does Company have a Disease Management vendor? If yes, who is the vendor?
Does Company administer a Health Risk Assessment Test? If yes, 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 BAS Behavioral Health 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.