Our services are available to you and your family members if your employer has Canopy for their Employee Assistance Program. If you would like to review your EAP benefits please log into our Member site for a complete description. The link can be found on the left of this page. If you are in an immediate crisis, please call 1-800-433-2320 for confidential assistance. We want to be able to provide you support at a time that is convenient for you and near your work or home. You can schedule an appointment by: • Calling us anytime at (800) 433-2320 • Completing the form below and submitting your request. Your request will be responded to within 48 business hours. Please note: Counselors are available by phone 24 hours a day, 7 days a week and services are confidential.
Request A Service Person Receiving Services First Name (required) * Last Name (required) * Medical Insurance (required) * DOB (required) * Please enter a date in the format MM/DD/YYYY for the DOB field. Address (required) * City (required) * State (required) * Zip (required) * Contact Information Email (required) * Phone (required) * Best Time To Reach You? Is it OK to leave a message? Yes No Is it OK to text? Yes No Preferred Contact Email Phone Reason Reason for seeking Services? Family Stress / Anxiety Work Issue Anxiety Depression Grief Trauma Life Adjustment Marital/Relationship Legal and Financial Other EAP Service Requested Face to Face Video Support Phone Counseling Legal Services Financial Services Child Care Life Coaching Home Ownership Other Person attending sessions or receiving services Employee Family Member Spouse / Significant Other Both Spouse/Significant Other Employee Info(required) First Name (required) * Last Name (required) * DOB (required) * Please enter a date in the format MM/DD/YYYY for the DOB field. Job Title of Employee (required) * Phone Numbers(optional) Employer (required) We will respond to your request within 48 business hours.