Tanner EAP Contact Form

Tanner EAP Contact Form

First and Last Name:*

Phone number:*

Phone

Best time of day to reach you by phone?*

Select all that apply

Select

Email address:*

Organization:*

What organization provides your EAP benefits? (i.e. your employer, your spouse's employer, etc.)

Select

Name of Organization*

If you chose Another Employer as the organization providing your EAP benefits, please name the organization here.

How Did You Hear About EAP?*

Select

Please specify

Concerns or questions:

No personal health information, please.

Which services are you interested in?*

Select all that apply

EAP counseling - Individual counseling

EAP counseling - Couples counseling

EAP counseling - Family counseling

EAP counseling - Children's counseling

Career services

Case management - Hardship

Case management - Eldercare

Well visit - Work/life balance

Well visit - Career development

Other

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