Your Request For* :
Please choose
Information
Quotation
Feedback
Contact
Relating to* :
Employee Assistance Program
Counselling
Psychological Therapy
eTherapy
Coaching
Career Coaching
CareerScope System
Management Consulting
Business Needs Analysis
Key note Speakers
Policy Development
Training
Testimonial/Feedback
Employment with Betterlife Directions
Other
How did you find us?*
Referral
Internet Search
Business Card
Advertisement
Other:
Your details
Your First Name* :
Your Last Name*:
Email Address* :
Your responsibility for the EAP
process* :
Decision Maker
Discover information and make recommendations
Committee Representative
Your Objectives (tick
all that apply)
Cost reductions
Productivity
Employee Retention
Absenteeism
Punctuality
Better Employee Satisfaction
Compliance
Employee Recognition/ representation
Employer's Duty of Care
WH&S Legislation
Risk
Company Culture and Climate
Stress Management
Individual Well Being
Loyalty and Commitment
Managerial Climate
Employer of Choice
Good Corporate Citizenship
Organisation details
Company Name* :
Business Address:
Telephone* :
Fax:
Website:
Operating Hours:
Office Locations:
Number of Employees* :
Other Relevant Details:
(include HR policies in place, nature of
industry/worksites etc)
Desired Support:
Work Life issues
eg. Family, Mariital, Couples, Health, Change, Adjustment
YES
NO
Career/Workplace
eg. Stress, Bullying and Harrassment, Redundancy, Retirement,
Exit Interviews, Safety, Health and Welfare
YES
NO
Critical Incident Stress Managament
(CSIM)
eg. Onsite on telephone debriefing and Psychological support
and guidane to reduce development of post traumatic stress
disorder.
YES
NO
Alcohol/Drug free Workplace
eg. Policy development, Training, Employee Assessment,
Counselling, Referral and Treatment programs.
YES
NO
Addictions/Dependency
eg. Alcohol abuse/misuse, Substance abuse/misuse, Gambling
YES
NO
Management Support & Training
eg. Develop the insight, skills and competencies to align
and maximise personal business performance.
YES
NO
Psychological
eg. Depression, Anger, Bereavement, Abuse, Anxiety, Phobias,
Eating Disorders, Post Traumatic Stress Disorder etc
YES
NO
Personal Development
eg. Enabling individuals to discover new possibilities, achieve
their goals and needs, professionally and personally.
YES
NO
Organisational Development
eg. Enabling the transformation of your organisation to the
deliberate design of your model/best-practice organisation.
YES
NO
Financial
eg. Services delivered by a qualified Financial Counsellor
for Budget Planning, Credit Card Abuse, Financial Stress,
Bankruptcy
YES
NO
Legal
eg. Personal legal advice and information with appropriate
boundaries.
YES
NO
Scope of Referral
The Scope of Referral determines who has the
authority to activate the service, which in tern determines
the training, communication and implementation requirements.
Tick all that apply.
Point of Referral
HR Referral
Management Referral
GP Referral
Medical/WH&S Officer Referral
Supervisor Referral
Permanent Staff Self Referral
Temp Staff Self Referral
Preferred EAP Model
(Select preferred model - choice can be changed)
Fee-for-service
This model is a pay as you use model, which
incorporates an annual administration fee, and monthly invoicing
for the services delivered per month.
Capitation Model
This model operates on a retainer basis whereby
you are billed once per annum for the total provision of standard
services to your organsation.
Customised Requirements
Please provide details of any specific or
unique requirements you would like included in your EAP.
The information you provide here will be considered with
the information already provided above, in determining the
most appropriate program for your organisation.
* indicates
required field