Initial Request for Services

Sutter EAP

This request form is for initial standard requests for services, where a response time of 2 to 3 days is acceptable. If your need is more urgent, please call us at 1-800-477-2258 or (916)614-2888.

If your request is for legal, financial or work/life services, please call us at the above number.

Show Confidentiality Statement and Cancellation Policy Content

Confidentiality Statement:

Our services are 100% confidential. When you contact us, it's strictly between you and our staff - your employer will not be notified and all information you share with us will be kept in the strictest confidence. There are some limits to confidentiality. We are required by law to report suspected child or elder abuse to the proper authorities. Similarly, if we believe that someone might harm themselves or others, we are required to take appropriate action.

24-Hour Cancellation Policy:

"No Show" or "Late Cancellation" of appointments will be counted as one of the client's authorized sessions. Please note: Providers bill Sutter EAP for sessions missed by our clients.

Items marked with * are required

I am requesting services for:
Employee Information
Identity

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I am the employee*

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Contact Information
Phone 1

May we leave a message at this number?

Phone 2

May we leave a message at this number?

Preferred contact method (Please select at least one)*

Please note: If you request a reply by email, Sutter EAP will send you an encrypted email message. If you are using an email address outside the Sutter system, such as Gmail or Yahoo, you will be required to register to open the encrypted email. This is to ensure confidentiality. If you are unable to open the encrypted message even after registering, please call us at 1-800-477-2258.


Additional Referrals
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Referral 1
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Additional Information

Is alcohol and/or drugs an area of concern?*

Availability

Please indicate your availability by selecting options below *

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Policies

Confidentiality Statement:

Our services are 100% confidential. When you contact us, it's strictly between you and our staff - your employer will not be notified and all information you share with us will be kept in the strictest confidence. There are some limits to confidentiality. We are required by law to report suspected child or elder abuse to the proper authorities. Similarly, if we believe that someone might harm themselves or others, we are required to take appropriate action.

24-Hour Cancellation Policy:

"No Show" or "Late Cancellation" of appointments will be counted as one of the client's authorized sessions. Please note: Providers bill Sutter EAP for sessions missed by our clients.

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