Are you an Employee or Family Member

Name of the Employer who sponsors the E.A.P.

Provider's Name

Date of the last E.A.P. visit

When I called the 800 number for a referral I received prompt and courteous service.

When I called the E.A.P. Provider I was given prompt attention.

When I called the E.A.P. Provider I was treated in a professional manner.

During my visit(s) to the Provider I felt that he/she was helpful and courteous. 

I believe my concerns remained confidential.

Did the provider refer you to other professional services?

Did you contact or utilize any of those services?

Were those services helpful?

Overall, in terms of the problem you sought assistance for, do you feel that the problem was:

In terms of overall satisfaction with the E.A.P. service, from the intake process to actual contact with the provider, how satisfied were you with the service?