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Schedule an appointment

Call 911

Call for appointment.

For matters of personal distress, please call the HumanaCare EFAP 24-Hour Crisis Line at 1-800-661-8193.

We offer confidential alternatives to request a counselling appointment. If you prefer, please call 1-800-661-8193 to directly arrange your appointment by speaking with a HumanaCare intake associate.

Request an appointment on-line / Email an appointment request.

Please complete the information in your on-line appointment request, or email us. One of our intake associates will call you to confirm your eligibility and determine the services you may require. If your voice mail is not private and confidential, we will only leave our personal name and phone number. We will not identify HumanaCare in our message.

If your request is submitted on a regular business day (Monday through Thursday, excluding statutory holidays) you will receive a phone call within 24 hours of submitting the request. If your request is submitted on a Friday or over the weekend, you will be contacted on the following business day.

Online Form


Please note: all fields must be completed.
Date of request:
Name:
What company/organization is your
coverage under?
Name of covered Employee/Member:

Please answer these questions if you are an individual that is not covered by an organization that sponsors the HumanaCare EFAP through a benefit plan.

Are you covered by an extended
health care plan?
Yes
No
If 'Yes', please tell us who is your
plan provider:
Do you have an EFAP provider?
Yes
No
Please tell us who is your EFAP provider:
Who is the appointment for?
Home Address:
City, Province/State:
Postal/Zip Code:
Date of birth:
Primary Telephone Number (incl. area code):
Home
Work
Mobile
Secondary Telephone Number (incl. area code):
Home
Work
Mobile
Where should we contact you?
Home
Work
Mobile
May we leave a message at home?
Yes
No
May we leave a message at work?
Yes
No
May we leave a message on your mobile phone?
Yes
No
Is your voice mail private and confidential?
Yes
No

If your voice mail is not private and confidential we will only leave our personal name and phone number. We will not identify the company name.

What is the best time to contact you?
What is the presenting problem?
Marital Status:
Single
Married
Common-Law
Separated
Divorced
Widowed
Additional Information and Comments:

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