Request an EAP appointment Please fill in your details below to make a request for an EAP appointment. Name First Last The name of your employer (i.e. organisation name)* Your preferred contact number*Your preferred email address: Your Date of Birth: MM slash DD slash YYYY Your work site/location (Suburb): We need this information to confirm that your employer has an agreement with us to provide you with EAP.Your preferred appointment days are: Monday Tuesday Wednesday Thursday Friday Your preferred time: Morning Afternoon After hours Your preferred appointment location/s: Melbourne City Frankston Wyndham Preston Ringwood Moonee Pnds Geelong Wangaratta Prahran via Telephone via Online Video link Other (for locations outside Relationship Matters branches) Who is the appointment for? Yourself Immediate Family Member/Partner If you have any specific requests (e.g. interpreters, convenient times to contact you) or queries around the appointment, please detail them below:NameThis field is for validation purposes and should be left unchanged. Δ
