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HMA and RGA Virtual Behavioral Health Solution Sign-Up

This form is intended for HMA and RGA Virtual Behavioral Health Solution sign-up with Canopy EAP. If you found this form by mistake or need assistance with signing up a new group, please email salesteam@canopywell.com or call 800-433-2320.

HMA and RGA Group Sign-Up

  1. (required)• We will not send unsolicited email nor share your email address with anyone. Ever.
General Information(required)•
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HMA / RGA Account Manager(required)•
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Broker Information(required)•
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Customer Information(required)•
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  15. (required)•
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EAP Services
  1. Contact Canopy with questions about rates.
Eligibility(required)•
  1. (required)•
  3. (required)•
Accounts Payable
  1. (for non-medical plan Members)