EAP Psychology Support Form

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EAP Psychology Support Form

Thank you for deciding to use your Employee Assistance Program. Please fill out the form below, and we’ll contact you to book you in.

First Name *

Last Name

Date of Birth *

Phone number *

Email Address *

Home Address *

Organisation Name *

Employee Number (if applicable)

Employement Location *

Days available for an Appointment *MondayTuesdayWednesdayThursdayFridaySaturdaySessions are only available from 9am to 5pm, Monday-Friday. Limited Saturday appointments will be available.

Preferred Time for an Appointment *Any timeMorning (9am-12pm)Afternoon (12pm-5pm)

Practitioner Preference *

Preferred Clinic *TelehealthAuburnDrummoyneGladesvilleGordonHornsbyNewtownNorth SydneyParramattaPlease select the most convenient for you, however, we cannot guarantee that your session will be held at this location.

Reason for Request (Please check all that apply) *Personal issues (e.g., stress, family problems)Work-related stress (e.g., job stress, conflict)Emotional health (e.g., anxiety, depression)Substance abuseLegal issuesFinancial concernsGrief or lossOther

If other, please specify:

Consent & Confidentiality *

I understand that the information I provide on this form will be treated confidentially and shared only with the EAP provider for the purpose of arranging services. I consent to the EAP services and understand that any counselling sessions are confidential and will not be shared with my employer. I acknowledge that my participation is voluntary.

About Us

We have 9 clinics across Sydney with 30+ practitioners. Ample parking is available at any location.

We offer psychological assessment and treatment for:

– Depression
– Anxiety and Phobias
– Relationships for Individuals and Couples
– Stress / Pain Management
– Grief and Loss
– Smoking Cessation
– Other Mental Health Issues

Find us on:

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