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Client Intake Form for Corporate Clients: Employee Assistance Programs (EAPs) for Workplace Wellness Programs

Company Information

Company Name

Company Address

City/Suburb

State/Province

Postal/Zip Code

Contact Person

Contact Title

Phone Number

Email Address

Industry

Number of Employees

Locations (List all locations)

Existing Benefits Programs (e.g., Health Insurance, 401k, etc.)

EAP Program Preferences

1. Program Goals:

What are your primary goals for implementing an EAP? (Check all that apply)

Reduce Absenteeism

Increase Productivity

Improve Employee Morale

Reduce Healthcare Costs

Support Employees During Organizational Change

Improve workplace safety

Address substance abuse

Other (Please specify):

2. Service Delivery Preferences:

How would you prefer employees to access EAP services? (Check all that apply)

In-Person Counseling

Telephone Counseling

Online Counseling (Video/Chat)

Mobile App Access

Educational Workshops/Seminars

On-site EAP representative

Address substance abuse

Other (Please specify):

3. Program Components:

Please indicate which EAP components are most important to your organization:

EAP component

Rate each from 1-5, 1 being least important, 5 being most important

A
B
1
Individual Counseling (Mental Health/Substance Abuse)
2
Legal Consultation
3
Financial Consultation
4
Stress Management Resources
5
Work-Life Balance Programs
6
Crisis Intervention
7
Management Consultation
8
Training programs for managers
9
Wellness programs (nutrition, fitness, etc.)
10
Childcare/Elder care referral services
11
Identity theft assistance

4. Specific Assistance Programs:

 

Please select which specific assistance programs are of interest.

 

Mental Health Services:

Depression and Anxiety Counseling

Stress Management

Grief Counseling

Trauma Support

Substance Abuse Services:

Assessment and Referral

Addiction Counseling

Relapse Prevention

Work-Life Balance:

Time Management Training

Parenting Resources

Eldercare Resources

Financial Wellness:

Budgeting and Debt Management

Retirement Planning

Credit Counseling

Legal Services:

Consultation on Legal Matters

Document Review

Wellness Programs:

Nutritional Counseling

Fitness Programs/Challenges

Smoking Cessation

Weight Management

Crisis Management:

Workplace Violence Support

Critical Incident Response

Management Support:

Conflict Resolution Training

Performance Management Guidance

Supervisory Skills Training

5. Communication and Promotion:

How would you like the EAP to be promoted to your employees? (Check all that apply)

Company Intranet

Email Announcements

Posters/Flyers

New Employee Orientation

Management Presentations

Employee workshops

Other (Please specify):

6. Reporting and Data:

What type of reporting and data would you require from the EAP provider?

Utilization Rates

Program Effectiveness Metrics

Aggregate Data (anonymized)

Custom Reports

Other (Please specify):

7. Budget Considerations:

Do you have a pre-determined budget for the EAP?

If yes, please specify:

What type of fee structure is preferred?

Per Employee Per Month (PEPM)

Fee for Service

Other (Please specify):

8. Integration with Existing Programs:

How will this EAP integrate with your current health insurance and other wellness programs?

9. Confidentiality:

Do you understand the importance of employee confidentiality within the EAP?

10. Implementation Timeline:

When would you like to implement the EAP?

Additional Comments

Signature

Client Representative Signature:

Client Intake Form Insights

Please remove this Client Intake Form Insights section before publishing.


Let's break down the EAP Client Intake Form and provide detailed insights into each section:


1. Company Information:


Purpose: This section establishes the foundation of the client relationship. It's crucial for accurate record-keeping, billing, and communication.

Insights:

  • "Number of Employees" is vital for determining program cost (especially with PEPM pricing) and estimating utilization.
  • "Locations" helps understand the geographical spread of employees, which impacts service delivery (e.g., in-person vs. remote).
  • "Existing benefits programs" allows the EAP provider to see what existing support structures are in place, and where the EAP will supplement current programs. This prevents overlap and highlights possible integration opportunities.
  • "Industry" gives context to the type of stressors employees might face.

2. EAP Program Preferences:


1. Program Goals:

Purpose: This pinpoints the client's primary objectives, ensuring the EAP is aligned with their strategic needs.

Insights:

  • Understanding the goals helps tailor the program and track its effectiveness.
  • For example, if the goal is "reduce absenteeism," the provider would focus on stress management, mental health, and substance abuse services.
  • "Improve workplace safety" would indicate the need for crisis management, and possibly training on workplace violence.

2. Service Delivery Preferences:

Purpose: This determines how employees will access the EAP, ensuring accessibility and convenience.

Insights:

  • Offering a variety of options (in-person, phone, online) caters to diverse employee preferences.
  • Mobile app access is increasingly important for younger demographics.
  • On-site EAP representative can be very useful for large companies, or companies with high stress environments.

3. Program Components:

Purpose: This section allows the client to prioritize specific EAP services, ensuring the program addresses their most pressing needs.

Insights:

  • The rating system provides a clear picture of the client's priorities.
  • High ratings for "crisis intervention" might indicate a high-stress or potentially dangerous work environment.
  • High ratings for "management consultation" indicates that the company is wanting to make sure that the managers are properly equipped to handle difficult situations.

4. Specific Assistance Programs:

Purpose: This dives deeper into the specific services within each component, offering a more granular level of customization.

Insights:

  • This section helps identify specific employee needs, such as depression, addiction, or financial struggles.
  • It is important to offer a wide range of services, because employee needs can be very diverse.

5. Communication and Promotion:

Purpose: This ensures effective communication and promotion of the EAP, maximizing employee utilization.

Insights:

  • A multi-channel approach is usually most effective.
  • Management presentations can help build trust and encourage employee participation.
  • New employee orientation is a great way to introduce the program from the start.

6. Reporting and Data:

Purpose: This outlines the client's reporting requirements, ensuring accountability and demonstrating the program's ROI.

Insights:

  • Clear and concise reporting is essential for demonstrating the value of the EAP.
  • Aggregate data ensures employee confidentiality while providing valuable insights.
  • Custom reports allow the company to track progress towards their specific goals.

7. Budget Considerations:

Purpose: This addresses the financial aspects of the EAP, ensuring a mutually beneficial agreement.

Insights:

  • Understanding the client's budget helps tailor the program to their financial constraints.
  • PEPM pricing is common and predictable, while fee-for-service offers more flexibility.

8. Integration with Existing Programs:

Purpose: This section ensures that the EAP works in conjunction with existing benefits programs, avoiding duplication and maximizing efficiency.

Insights:

  • This helps avoid gaps in coverage and ensures a seamless employee experience.
  • Coordination with health insurance providers is crucial for mental health and substance abuse services.

9. Confidentiality:

Purpose: This reinforces the importance of confidentiality, building trust and encouraging employee utilization.

Insights:

  • Clear and consistent communication about confidentiality is essential.
  • Employees must feel safe and secure when accessing EAP services.

10. Implementation Timeline:

Purpose: This establishes a timeline for implementing the EAP, ensuring a smooth and timely rollout.

Insights:

  • A realistic timeline is essential for successful implementation.
  • Consider factors such as employee communication, training, and program setup.

Key Takeaways:

  • This intake form is designed to be comprehensive, covering all essential aspects of EAP implementation.
  • It emphasizes client customization, ensuring the program meets the unique needs of each organization.
  • It prioritizes clear communication, confidentiality, and data-driven results.
  • The form creates a strong foundation for a successful EAP partnership.
  • The information gained from the form, allows the EAP provider to create a very detailed proposal that will address all of the clients concerns, and needs.

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