This page will link you to The Carebridge EAP Network Intake Record Submission Form. In order to assure the confidentiality of your submission, this form is located on a secured server, and your browser may display a message alerting you to this fact. If so, simply accept any security warnings and proceed to the secured form.

Please note: This form has been updated and moved to a new location. When you click the link below and arrive at the new form, please BOOKMARK the new web address of the form and DELETE any old bookmarks you may have saved.

If you require technical support in accessing the form, please contact Carebridge Support by calling 1.800.437.0911.

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Revised 9.30.2013