INTERFACE Interest Form (original) (raw)

Thank you for your interest in becoming a subscribing community in the INTERFACE program! Please complete this form to receive an information packet via email. Someone will follow up shortly.

NOTE:

If you are already a member of one of our subscribing communities and are seeking a referral for mental health services, please call the Helpline, 888-244-6843 (toll free) Mon/Wed/Fri from 9am – 5pm or Tues/Thurs 8am-6pm to speak with one of our counselors. If you are not a member of a subscribing community, we suggest reaching out to your Insurance Company or your PCP for referral information.