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1300 364 273
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Menu
About Us
Our Story
Our Brand
Services
Employees
Leaders
Organisations
Offering
Framework
Service Delivery
Quality Standards
How We Give Back
Acacia Wishes
GROW Program
Research
Resources
Locations
Connect
Contact Us
Connect Lines
Appointment Hub
Request an Appointment
Request an EAP Proposal
Request an
Appointment
Complete the form below to request an EAP session with an Acacia Professional. All details remain confidential and are never sent to your employer.
If you require immediate support please call directly on 1300 364 273 (AUS) or 0800 000 657 (NZ).
Have you contacted Acacia EAP before?
Yes
No
What is your full name?
What is your best contact number?
What is your email address?
What organisation are you associated with?
What business unit within the organisation do you fall under?
How are you connected to the organisation?
Employee
Family Member
Contractor
Student
Volunteer
Customer
If you are a family member of an employee, what is your relationship to them?
Spouse/Partner
Parent
Child
Grandparent
Niece/Nephew
Other
Prefer not to say
Have you used any EAP service before with any provider?
Yes
No
Prefer not to say
What is your date of birth?
What gender do you identify with?
Female
Male
Trans-gender
Non-conforming / Variant
Prefer not to say
What state are you based in?
Queensland
New South Wales
Victoria
Western Australia
Tasmania
Northern Territory
Australian Capital Territory
South Australia
New Zealand
International
If International, please specify
What suburb do you live in?
What suburb do you work in?
How did you learn about the service?
Promotional Material
Colleague
Manger
HR / H&S
Intranet
Staff Newsletter
Awareness Session
Training Session
Policy Document
Not Applicable / Family Member
Prefer Not to Say
What is your employment status?
Full-time
Part-time
Casual
Contractor
Prefer not to say
Not Applicable / Family Member
How long have you worked for the organisation?
0-12 Months
1-2 Years
3-5 Years
6-10 Years
11-20 Years
>20 Years
Not Applicable / Family Member
In a few words, what is the main reason you are seeking counselling?
What delivery method is best suited to you?
Phone
Video
Online Chat
Face-to-Face
Preference 1
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Weekend
Time
Morning (9am - 12pm)
Afternoon (12pm - 4pm)
Evening (After 4pm)
Preference 2
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Weekend
Time
Morning (9am - 12pm)
Afternoon (12pm - 4pm)
Evening (After 4pm)
Send