Request a Referral

Online Request for EAP/MAP/PAP Services


If you are experiencing a life-threatening situation please call 911 or immediately go to an emergency room.

If you are experiencing suicidal thoughts, homicidal thoughts, or domestic violence, DO NOT complete this form. Please call our 24/7 toll-free number at 1(800) 777-4114.


* denotes required field
Welcome to First Choice Health EAP’s online referral request tool!

The EAP will use this information to directly match you with a provider. We will reach out to you within 48 business hours with any updates or questions regarding the status of your referral.

Please note, online requests are monitored Monday – Friday, 8am-5pm PST. If you are experiencing a crisis or need support outside of these hours call 1(800)-777-4114

Contact & Eligibility
Date of Birth
Primary Phone Extension

The following information will be used to match you to a provider. Once you have been matched, the provider will call you within 2 business days to schedule the first appointment. If you have not heard from a provider after being matched, please contact us at 1-800-777-4114.

First Choice Health strives to match all client requests but cannot guarantee every request. Please note that our criteria is to match you with a provider whose first appointment is available within two weeks. Scheduling delays may result due to specific requests, limited availability or popular timeslot requests such as evenings.

Referral Information and Preferences
Scheduling Preferences

Please Note - If you are seeking a referral for a client under the age of 13, a parent or guardian must attend.


FIRST CHOICE HEALTH EAP TERMS AND CONDITIONS


By submitting this online referral, you acknowledge that you have read and understood the terms and conditions below and are not at risk of harming yourself or others.

  1. You agree that you are currently at no imminent risk of harming yourself or others. If you are having thoughts or have intent of harming yourself or others, please immediately contact the EAP at the number listed above or call 911 or 988 for immediate support.
  2. You must have one working phone line available with an activated voicemail box where voicemail messages can be received OR an active email account in which the EAP can send confidential messages.
  3. Once you are matched, you should expect to receive contact via your preferred method directly from an EAP provider within 48 business hours to schedule your appointment (excluding holidays and weekends).
  4. You understand that the goal of the EAP is to provide an appointment time within two weeks of this request. However, if your only availability is outside normal business hours (M-F 8am-5pm), please be aware those appointments can take significantly longer.
  5. Please be aware that First Choice Health EAP is not affiliated with any insurance company, although we attempt to, the EAP cannot guarantee to connect you with an EAP provider that also accepts your health insurance.
  6. Please be aware the EAP cannot assist with medications or signing outside paperwork, including but not limited to FMLA, court orders, or service animal certification.
  7. Please be aware that late cancelations or no-shows to your EAP appointment count against your total allowable EAP sessions.
  8. If you feel that the EAP provider is not a good fit after the first session, call First Choice Health EAP at 1(800) 777 - 4114 before scheduling a second session to receive a re-referral. No re-referral is available if a second session has been created.
  9. By completing this online request, you agree to allow First Choice Health EAP to send you a survey upon 30 days of this request via email. Please help us support you by providing feedback on your experience.
By submitting this request, you acknowledge that First Choice Health EAP or an EAP provider will contact you to schedule an appointment. Additionally, you acknowledge that late-cancellations & no-shows count against your available sessions. You are only eligible for a re-referral if requested after the first session but before scheduling a second.


Submit