PrismCare™ EAP Enrollment

Fill out the following form to apply for enrollment in PrismCare™. If you have any questions, please let us know. Upon approval, we'll send you the contract and invoice for payment, then followup with instructions for onboarding.

Have Questions First?

Email or call us at (480)525-7284 to discuss the needs of your organization.

ORGANIZATION INFORMATION

* Indicates required field

Name of Organization *

Organization Type *

If other, explain: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Website *

CONTACT INFORMATION

Primary Contact Name *

First

Last

Title/Role *

Email *

Phone Number *

ENROLLMENT DETAILS

How many employees would you like to enroll? *

Do you currently have an EAP? *

Yes No Unsure

Any questions or comments? *

ACKNOWLEDGEMENTS

I understand that each enrolled employee receives access to up to 3 counseling sessions, unlimited Christian DISC® assessments for our organization, and wellness tools for a 12-month term. *

Yes

I acknowledge that unused sessions expire after 12 months unless renewed. *

Yes

I confirm that the information provided above is accurate. *

Yes

Submit Application