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DEPENDENT INTAKE QUESTIONNAIRE
THE SCHOOL BOARD OF BROWARD COUNTY, FLORIDA
EMPLOYEE ASSISTANCE PROGRAM
Office Use OnlyPLEAE Princeliest # :LAST NAME
Sex:Mandate :FIRST NAME. I. Females 4 digits of
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How to fill out eap referral form
How to fill out eap referral form
01
Obtain the EAP referral form from your employer or HR department.
02
Fill out your personal information, such as name, contact details, and employee ID.
03
Provide details on why you are seeking EAP services and the type of support you are looking for.
04
Sign and date the form to acknowledge your consent for EAP services.
05
Submit the completed form to the designated individual or department as indicated on the form.
Who needs eap referral form?
01
Employees who are experiencing personal or work-related issues that may benefit from counseling or support services.
02
Employers who want to provide their employees with access to resources for mental health and well-being.
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