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

Program Effective Date *
Program Effective Date
Halcyon Contact Name *
Halcyon Contact Name
Halcyon Contact Phone Number
Halcyon Contact Phone Number
Client Contact Name
Client Contact Name
Client Contact Address
Client Contact Address
Client Contact Phone Number
Client Contact Phone Number
(if applicable)
(choose one)
(choose one)
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)?
(if applicable)