Welcome to Southwest EAP
Please review and complete the form below prior to your appointment with Southwest EAP.
Southwest EAP Intake Form
Southwest EAP is a private employee assistance program contracted by your employer to provide assessment, evaluation, and referral services for a wide range of problems. Those accessing these services will be treated with dignity and respect, regardless of race, creed, religion, disability, sexual or affectional orientation. Voluntary use of EAP services will not jeopardize your employment or job status.
There is no cost to your or your family when being seen by SWEAP staff. Your employer has paid for this benefit. When referrals to outside services are made, there may or may not be a cost, depending on the terms of your health insurance plan.
Explanation of Services
Southwest EAP provides assessment and evaluation services. We also provide brief or "short term" therapy for problems. If our initial assessment indicates that the problems you are experiencing cannot be resolved with short-term therapy, we will refer you to a qualified specialist. When referrals to outside services are made, there may or may not be a cost, depending on the terms of your health insurance plan. These referrals are made in your best interest, and every effort is made to refer you to a provider covered by your insurance policy.
Southwest EAP will not share any information concerning an individuals's use of the EAP with the employer, family members, or any other person without the individual's written permission, except as required by law in cases where clients express the intention of harming themselves or others, or in the event of child or elder care abuse, or if court ordered. The privacy of your health information is also protected under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Our Notice of Privacy Policies are available to you at any time through our front office. Please ask your counselor to discuss these issues about confidentiality in detail if you have any further questions.
Please ask your counselor to discuss these issues about confidentiality in detail if you have any further questions.
Southwest EAP is concerned with providing you quality service. We will follow up with you by phone, email and/or letter after your contact at SWEAP to ensure your satisfaction with the services rendered. Additional questions or comments about your experience can be directed to us through our toll free number 1-800-777-1797 or at sweap.flywheelsites.com.
Acknowledgement of Understanding
By signing the statement below, you acknowledge that you have read this form and understand its contents. Additionally, you acknowledge the offer and availability of the Notice of Privacy Practices.