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Request a Phone Consultation



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Requestor Information
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Male   Female

Contact Information
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Attention!
Once your request is received and reviewed by our Intake Specialist, you will contacted by phone. Call backs take place between 9 am and 4 pm Pacific Time, Monday through Friday.

If we need to contact you via email to coordinate your request, we will be using secure email for that communication. You would receive an email from an "@optum.com" email address with instructions on how to retrieve your secure email. This process has been implemented to guarantee your privacy and security.




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No   Yes
If "Yes" is selected, manager's name and phone number required.
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About the Employee (policy holder)
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 [HMO, PPO, etc.]
What is your relationship to the employee (policy holder)? *
   Self    Dependent
   Spouse    Other

   

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