EAP Member Booking Form - DFS Consulting
Psychological Counseling, Psychotherapy, Hypnotherapy, Life Coaching, Personal Development. Private Individual & Corporate Training, Seminars, Workshops & Employee Assistance Program (EAP)
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EAP Member Booking Form

Employee Assistance Program (EAP) Member

Appointment Booking Form

*only for corporations’ employees enrolled in our program

    Company Name:
    This booking is for your SelfFamily Member
    Full Name
    Age
    Department
    Phone
    Company Email Address

    EMERGENCY CONTACT:
    Contact Person & Relationship
    EMERGENCY CONTACT:
    Contact Number

    Tentative Date of Appointment (give options)
    Preferred Time (give range)
    Urgent? YesNo

    How do you want to avail of the Online Service? ChatVoiceVideo with voice

    Where do you prefer? ViberWhatsappZoomJusTalkTelegramLineGoogle Meet

    Language Spoken TagalogEnglishBisayaCebuanoIlonggoChavacano

    What service do you wish to avail now? INDIVIDUAL: Assessment/Counselling/Therapy-PsychologistCOUPLES: LGBTQ+-PsychologistCOUPLES: Non-marital Counselling-PsychologistCOUPLES: Marital Counselling-PsychologistGROUP: Family Therapy-PsychologistGROUP: Coaching or Debriefing-PsychologistMEDICINE ePrescription-PsychiatristDOCTOR: Orthopedic (musculoskeletal)DOCTOR: ENT (ears nose throat)

    Did you had any suicidal thoughts or attempts for the past days / weeks? YesNo

    Primary Concerns / Message / Symptoms

    You have read, understood and agreed with the Confidentiality and Privacy Agreement Yes

    NOTE: Please check your email (also spam) for appointment confirmation.