Online Request Form

Use the form below to submit questions about your EFAP program, our services, program eligibility, or to request a call-back to do an Intake call for a referral to counselling or one of our work-life services*.  A request for counselling services will require a phone follow up, so please ensure you include your phone number below.  We will respond to inquires M-F, 9:00am to 5:00pm.
(*Please note, form & email internet submissions are not fully secure, therefore use discretion when sharing detailed personal information.)

For immediate assistance, or to complete a counselling service intake, please call our 24/7 Care Centre Line at 1-800-667-0993.
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