Please complete the form below to begin the EAP transition and implementation process from Centerstone Solutions to CuraLinc Healthcare. Your CuraLinc Client Relationship Manager will send a confirmation of receipt within two business days.

Client Name

Program Effective Date

A request for a July 1, 2023 effective date must be submitted by May 15, 2023.

MM

DD

YYYY

Client Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Number of Employees

Client Contact Name

First Name

Last Name

Client Contact Email Address

Client Contact Phone Number

(###)

###

####

Broker/Consultant Information

(if applicable)

Plan Design (Session Model)

Telephonic

3-Session

5-Session

6-Session

7-Session

8-Session

10-Session

12-Session

EAP Website Username

This will be the group code employees will recognize within the program URL and the code they will use to log in.

Utilization Review (UR) Vendor

Does your company have a UR vendor? If so, who is the provider?

MHSA Network

Does your company provide mental health and substance abuse (MHSA) benefits? If so, what is the company's MHSA network(s)?

Additional Information

Note: In addition to short-term counseling, all 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. All programs also include access to worksite service components, such as critical incident response services and training.

Centerstone Solutions

New Client Implementation Form