Begin a referral request on-line by accepting the terms and conditions below
By clicking the "I accept" button below you acknowledge that you have read and understood the terms and conditions below and are not at risk of harming yourself or others.
You agree that you are currently at no imminent risk of harming yourself or others. If you are having thoughts or have intent of harming yourself or others, please immediately contact the EAP at the number listed above or call 911 for immediate support.
You must have one working phone line available with an activated voicemail box where voicemail messages can be received. The EAP will assume that a detailed voice mail message can be left on the first phone number listed on the form. If you would not like a voicemail message left, please use the 2nd space to ensure this is not done.
You should expect to receive a phone call directly from an EAP provider to schedule your appointment within 24 – 48 business hours (excluding holidays and weekends)
You understand that the goal of the EAP is to provide an appointment time within two weeks of this request. However, if your only availability is outside normal business hours (M-F 8am-5pm), please be aware those appointments can take significantly longer
Please be aware that First Choice Health EAP is not affiliated with any insurance company, although we attempt to, EAP cannot guarantee to connect you with an EAP provider that also accepts your health insurance.
Please be aware that late cancelations or no-shows to your EAP appointment count against your total allowable EAP sessions.
If you feel that the EAP provider is not a good fit after the first session, call First Choice Health EAP at (800) 777 – 4114 before scheduling a second session to receive a re-referral. No re-referral is available if a second session has been created.