• Service Request Form

    Use this form to submit a service request.

  • FSEAP professional and confidential employee/member and family assistance and support services are available to eligible employees/members and their immediate family members. Please answer the following questions to initiate your service request. No personal or identifiable information is shared with your organization or others without your consent.

    Please note: Your benefit may not include all of the services described. Gain more information from your benefits material or by contacting your Human Resources/Benefits department.

  • Not all situations are suited to our online service request process. For that reason, we assess for situations that may require a more urgent response and a telephonic assessment to better understand your current needs.
  • Do you believe there is a risk of harm to you or anyone else at this time?*
  • Please confirm your answer. You have indicated there is a risk of harm or violence to yourself or others at this time, is that correct?*

  • Attention

    Given that you have responded "yes" to the risk of harm question, please call your local emergency or our toll-free number at 1-800-667-0993; 24 hours a day, a representative will connect you to the immediate support you require.

    Return to myfseap.ca

  • Personal Information

    Please provide the information requested below.
  • Date of Birth (MM-DD-YYYY)*
     - -
  • Eligibility Type*
  • Rows
  • Preferred Language*
  • Does FSEAP have permission to email you?***

  • **By checking "yes" to email communication above, I hereby give permission for FSEAP to send electronic information to the email address indicated and affirm my understanding that information in an email may not be fully secure.

    Please note: by checking "yes" you will receive an email confirming receipt of your service request submission with the information entered. If you check "no", you will not receive a copy of your submission request. 

  • I consent to receive a brief FSEAP Client Satisfaction Survey by email.*

  • Your feedback helps us improve access, service quality, and the client experience. Participation is voluntary and the survey takes only a few minutes. This consent is separate from the email communication permission above.

  • Format: (000) 000-0000.
  • It is okay to leave a message?*
  • Format: (000) 000-0000.
  • It is okay to leave a message on alternate phone number?
  • Format: (000) 000-0000.

  • Service Request

  • Counselling Service Presenting Issue--Please indicate your primary area of focus:*
  • Do you have a preference for the gender of your therapist?*
  • Guided iCBT Presenting Issue--Please indicate your primary area of focus:*
  • Child Care Consultation Presenting Issue--please indicate your primary area of focus:*
  • Elder Care Consultation Presenting Issue--please indicate your primary area of focus:*
  • Life Coaching Presenting Issue--please indicate your primary area of focus:*
  • Career Counselling Presenting Issue--please indicate your primary area of focus:*
  • Financial Coaching Presenting Issue--please indicate your primary area of focus:*
  • Legal Advisory Consultation Presenting Issue--please indicate your primary area of focus:*
  • Health Coaching Presenting Issue--please indicate your primary area of focus:*
  • Nutrition Counselling Presenting Issue--please indicate your primary area of focus:*
  • Please select your desired Resource Kit?
  • Rows
  • Smoking Cessation Support--please indicate your primary area of focus:
  • What is your preferred medium for accessing service?*
  • What is your preferred medium for accessing service?*

  • **Please note: If your preferred medium for accessing service is not available in your area, you will be offered telephone-based service.

  • Rows
  • Would you like a call back first to discuss the therapist you are being matched with?
  •  
  • Should be Empty: