Get an EAP Quote

If you are human, leave this field blank.

Company Name *

Company Address *

Contact Name *

Contact Title *

Contact Phone Number *

Contact Email *

Number of Employees *

Are Employees all located at the same location? *

Yes

If no, please explain

Do you currently offer an Employee Assistance Program to your employees?

Yes

If yes, name of vendor; number of sessions; Per Member Per Month rates; and what is the utilization percentage, if known?

Do you currently offer Work-Life Services to your employees?

Yes

If yes, name of Vendor; is the program web access only or a complete resource and referral service; Per Member Per Month rates; and what is the utilization percentage, if known?

Which Services would you like MHC to provide a proposal for? Check all that apply:

Employee Assistance Program: 3 Sessions

Employee Assistance Program: 5 Sessions

Employee Assistance Program: OtherEmployee Assistance Program: Other

Work-Life Service - Complete Resource and Referral Services (includes web access)

Work-Life Service - Web access only

Would you like information on Behavioral Health Care Management Services?

Yes

Would you like information on Prescription Monitoring Programs?

Yes

Would you like information on Wellness Programs?

Yes

Would you like information on DOT Services?

Yes

Comments:

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Other options

You may also contact Valerie Salico, Executive Director, directly at vsalico@mhconsultants.com to discuss MHC’s programs in more detail or to request a proposal.

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