Ready to Sign Up?

Please fill out the form below to start offering Patient Overwatch as your new Employee Assistance Benefit. After, we will reach out with a basic Business Agreement (you can cancel the service at any time with no obligations).

Patient Overwatch Employee Assistance Program is a special, invitation only, purchase program that provides a valuable benefit that a company can offer to their employees

The program is automatically extended to all company employees and their immediate families, giving them the ability to take advantage of our programs not provided to the general public. Enroll your company and employees by simply filling out this form. Employee information is never ever asked for or required. Patient Overwatch information shall be provided online (private company web page and by digital PDF information packets to be distributed to your employees as part of your benefits package.

First name

Last name

Phone

Position in the Company

Company name

Company Address

HR Contact

HR Contact Email

Number of employees:

Number of locations:

How do you distribute employee benefit information?

How often is it sent out to employees?

Signature

Date