Employee Assistance Program Set Up

This form is intended for Samaritan Health Plans employees who wish to sign up a new EAP client. If you found this form by mistake or need assistance with signing up a new group please email info@cascadecenters.com or call 800-433-2320.

Samaritan Health Plans EAP Set Up

Your Email Address (required) We will not send unsolicited email nor share your email address with anyone. Ever.

Personal Info(required)

First Name (required)
M.I.
Last Name (required)

Phone Numbers(optional)

Work Phone (optional)

Please Tell Us About The Group

Company Name
Number of Employees
Estimated Start Date
Company Address
Please list all locations.
Company Primary Contact
Company Contact Email
Company Contact Phone

Please share any additional important information

Please Don't Enter Anything In This Space

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