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When you’re ready to talk, we’re ready to listen.

Call us today or complete this online form. Students are allowed up to three sessions per semester.

All information is confidential and will only be viewed by certified M&S EAP staff.

"*" indicates required fields

Name*
MM slash DD slash YYYY
Address*
We will not mail anything to you without your permission.
May we leave a message?*
If we have to contact you on the phone, may we leave a detailed message?
How do you prefer to be contacted?*
Please let us know the best way to contact you.
INSURANCE INFORMATION - OPTIONAL
Sometimes sessions go beyond what the employee assistance program offers and it is billed to an insurance company. We want to make sure our recommended provider accepts your insurance, and some providers like to have this information handy if you opt to go beyond the EAP sessions.
REFERRAL INFORMATION
The more you can tell us about your situation, the better we can direct you to an appropriate resource.
What resource can we help you with*
Check all that apply.
We want to match you up with someone who will be a good "fit" for you! Please tell us if you have any preferences, such as a male or female counselor, preferred location for services, etc.
What type of counseling would you prefer?*
THANK YOU
Thank you for reaching out to M&S EAP Services. When you hit submit, your information will be forwarded to someone on our team who will get in touch with you by the end of the next business day. If you need anything in the meantime, please feel free to call us at (800) 543-5080 or email us at [email protected]. While we strive to contact people in the method they request, please note that even if email is preferred, we may need to call you. By hitting "submit," you understand that you are requesting that M&S EAP provide assistance to you.
This field is for validation purposes and should be left unchanged.