Welcome to First Choice Health EAP’s online referral request tool. Please fill out the information below, acknowledge EAP polices and
submit your request. Once submitted, a representative will reach out to you in 2-3 days with your referral information. These referrals
are monitored Monday – Friday from 8:00am-5:00pm.
If you are in crisis or need immediate support, please call us 24/7 at 1-800-777-4114.
First Choice Health will use this information to reach you with questions or updates. A provider will call you within 48 business hours to
schedule the first appointment. If you have not heard from a provider, please call us at 1-800-777-4114.
Please note online requests are monitored Monday – Friday 8am-5pm PST. If you are experiencing a crisis or need support outside of these hours
Contact & Eligibility
**Adults 18 years and over must request services for themselves
You must select Yes for Leave a Message for either the primary phone or secondary phone.
**Please note that completing this form will result in email confirmation and customer satisfaction survey. Enter “N/A” if you do not wish to receive emails.
Referral Information and Preferences
First Choice Health strives to match all client requests but cannot guarantee all requests. Please note that our criteria is to match to a counselor within 15 miles or 30 minutes with a first appointment available
within two weeks. Scheduling delays may result due to specific requests, limited availability or popular timeslot requests such as evenings.
If you are in crisis, please call us at 1-800-777-4114 for immediate service.
**Please note – we can only discuss referral information with primary client.
**Leave blank if you do not wish to use insurance afterward.
Category of Problem missing or too many checked items
By submitting this request, you acknowledge that FCH EAP or an EAP provider will contact you to schedule an appointment. Additionally, you acknowledge that late-cancellations & no-shows
count against my available sessions. You are eligible for a re-referral if requested after the first session but before scheduling a second.