Prospect / Inquiry

Thank you for your interest in learning more about EAPCare, Inc.  Our program is designed to confidentially assist your employees and their covered family members with a full range of services when personal problems arise….problems that can affect your employee’s career and, more importantly, their life.  We consider it a privilege to speak with you about your EAP needs.  Just complete the following form and click ‘Send’ to learn more about our services.

* Your Company Name:

* Street Address:

* City, ST, ZIP:

* Contact Person:

Number of employees:

* Phone Number:

Fax Number:

* Email Address:

Name of nearest County Hospital:

Do you currently have an Employee Assistance Program:

Name of your current EAP Vendor, if applicable:

EAP Company Name:

EAP Street Address:

EAP City, ST, ZIP:

Is current EAP Fee For Service?:

Is current EAP a Capitated Program (charge per member)

If in EAP Program, how many sessions are provided?:

Are you familiar with EAPCare,Inc employee assistance programs?:

Would you like to receive EAPCare, Inc. information?:

Would you like to meet with one of our professionals?:

Best day of week to meet:

Best time of day to meet:

Name of person completing request, if not the Contact Person:


Chattanooga, TN

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