Please complete the form below to notify CuraLinc Healthcare of a new 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
Contact Name at Partner or Reseller *
Contact Name at Partner or Reseller
Contact Phone Number at Partner or Reseller
Contact Phone Number at Partner or Reseller
(if applicable)
Client Broker Phone
Client Broker Phone
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 provide mental health and substance abuse (MHSA) benefits? If so, what is the company's MHSA network(s)?