MeHelp EAP Business Registration

Employee Assistance Program (EAP) Registration Form

Please fill in the form below
Business Name*
ABN*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business Contact*

First NameLast Name
Title/Position
Email*
Phone Number*

Area CodePhone Number
Secondary Contact

First NameLast Name
Title/Position
Email
Phone Number

Area CodePhone Number
Have you previously used an EAP Service for your business?
What is the maximum amount of counselling sessions you would like to offer your staff per calendar year?
How would you like your Emoployees to access counselling services?

HR Referred (Employees must go through HR to access counselling sessions)Self-Referred (Employees have the ability to call MeHelp and use the EAP plan at their own discretion)
Contact MeHelp Online Psychology
For any questions registering your business or for more information, please contact us:

Email: info@mehelp.com.au
Phone: 1300 323 411
Website: www.mehelp.com.au
Please verify that you are human*
Should be Empty:

Employee Assistance Program (EAP) Registration Form