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Northstar Employee Assistance Program

Online Request for Services Form


If you are a returning client and it has been more than one year since your last appointment or your employer has changed, we request you complete the intake form below.

This form is required to be completed before clients can access counseling through their EAP benefit.

*If this is an EMERGENCY please call 911 or your health care provider*


* denotes required field
Confidential EAP Intake Form
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Health Insurance Information
Health Screening Questionnaire
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PHQ-9 - Over the last 2 weeks, how often have you been bothered by any of the following problems?
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GAD-7 - Over the last 2 weeks, how often have you been bothered by any of the following problems?
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Submit