EAP Appointment Request Form
BRiDGES Employee Assistance Program would be happy to speak with you. Please fill out this form and someone from our team will reach out to you. We can be contacted by phone Monday-Friday 8AM to 5PM at 315.697.3947 Please note, this form will not be monitored outside of business hours. If this is an emergency, please call 911, or go to your local emergency room. If you are experiencing a mental health crisis, call 988 or visit https://chat.988lifeline.org/ Please note, you cannot request an appointment for another adult.
Name
*
First Name
Last Name
Phone Number
Can we leave you a voicemail?
Yes
No
Email
example@example.com
Have you ever called EAP before?
*
Yes
No
Who is your employer?
*
What are you looking for support with?
Work Stress
Grief and Loss
Relationship
Mental Health
Family Stress
Addiction
Other
What would you like us to know?
Thank you. Someone from the BRiDGES EAP team will reach out to you during regular business hours.
Submit
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