Recuro Transmittal Data Form

Recuro Transmittal Data Form

Please complete this short workbook so the proper information is transferred to Recuro Health
There are only 2 types of enrollment options in this system ("new hires" or "new account"). If this is an EXISTING account and you are adding people please mark NEW HIRE.
Agent Name*

First NameLast Name
Your email*
example@example.com
Your Phone Number*
Please enter a valid phone number.
Account Name*
Type of Enrollment*

NEW HIREFIRST ENROLLMENT
How many enrollees?
Should be Empty: