Clients Forms

ENCOMPASS offers clients access to online forms as an easy way to contact us regarding a service need. You can also contact ENCOMPASS by calling our toll-free phone number or by contacting your ENCOMPASS account manager directly.

To use an online form, select from the following:

• Case Management Referral
  Use this form to submit a referral to ENCOMPASS Case Management.

• Workers' Compensation Referral
  Use this form to submit a referral to the ENCOMPASS Worker's Compensation program.

• Network Customer Service Request Form
  Use this form to submit an ENCOMPASS network customer service inquiry.

• Baxter Referral Form
  Use this form to begin Primary Care Network (PCN) Physician Referral Authorization for Baxter members.

• Contact Us
  Use this form to submit general questions, concerns, inquiries, or requests related to ENCOMPASS or our services.