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If you have any questions or concerns, you may call the Intake Department at 800-327-5071 during the typical daytime hours of 8:30 AM – 5:00 PM CST Monday through Friday.
By clicking “Submit” you acknowledge and agree that you have already entered into a Business Associate Agreement (“BAA”) with Workplace Solutions. This Submission is a permitted disclosure as set forth in Section 2 of the BAA because you are using and/or disclosing any applicable PHI merely to comply with proper management and administration, and all information submitted will be held confidentially and used only as required by law or for purpose for which it was disclosed.
New Affilate Application.pdf