Reason for Request
Employment Information (Your information is confidential and will not be shared with your employer)
Workplace Outcome Suite (The Workplace Outcome Suite (WOS) is a brief, psychometrically robust tool that clearly documents the impact of your EAP workplace intervention.)
In utilizing this inquiry form, I hereby agree to accept a response via email or phone using my contact information in this form. I understand that email is not always secure.

I understand that submitting an inquiry does NOT create a client-provider relationship.

I understand that if I am experiencing a physical or behavioral health emergency, I should not submit this form. Instead I should call 911 or go to my nearest hospital. And, I should call 988 promptly if I am suicidal or having thoughts of harming myself.

Please answer all questions then click on "Submit". An intake associate will contact you by the following business day to assist you with scheduling an appointment and to answer any questions.