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Employee Assistance Quote Request Form

 

Thank you for your interest in a quote for EAP services from Providence Employee Assistance Program. We proudly serve employers and union groups based in the Pacific Northwest some of whom have employees based throughout the fifty United States. Whether you are a small employer, large employer or benefits broker we are happy to discuss options for services for your group. We sincerely believe the health of the workplace is dependent on the positive well being and health of your workforce and we are happy to assist you in promoting this endeavor. Please complete the form below and we will contact you with a quote for adding this option to your employee benefit package.

Questions and Contact Information (Fields marked with * are required)
Full Name*
E-mail Address*
Employer*
City
State
Phone Number*
Best Time to Reach You
Number of Employees to be covered*
Coverage Options
Does this employer group currently offer Providence Health Plan as an option to employees? Yes    No
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