NEW GROUP SIGN UP

This form is intended for new employer groups signing up with Cascade EAP. 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.

EAP New Group Sign Up


  1. (required) We will not send unsolicited email nor share your email address with anyone. Ever.
General Information(required)
  1. (required)
  2. (required)
(required)
  1. (required)
  2. (required)
  3. (required)
  4. (required)
Accounts Payable(required)
  1. (required)
  2. (required)
  3. (required)
  4. (required)
Company and Benefits(required)
  1. (required)
  2. (required)
  3. (required)
  4. Eligibility Criteria:
    If you answered "other" please provide additional information
  5. (required)
  6. If you answered "yes" please provide the city and state of each location in the "locations" section below. Or you may email your account manager your list.
(required)
  1. (required)
EAP Services
  1. Contact your account manager for pricing questions.
Broker Information
  1. Renewal information will be sent 90 days prior to renewal unless otherwise requested.
Additional Information