BCHHC EAP Form

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BCHHC EAP Form

This form is ENTIRELY confidential. The only person able to access it is Dr. Arynne Horton and the BCH Behavioral Health Assistants for scheduling purposes. No BPS employee or administrator can review this document. The information you submit will only be shared with BCHHC staff for the purposes of scheduling or direct therapy.

The BCH Behavioral Health Team is committed to quality behavioral health services for our patients, BPS students, and BPS staff. You are likely here to fill out this form because you are experiencing some challenge. Congratulations on taking this first action step toward improving the situation! We are looking forward to partnering with you; we just need some information from you to get started.

Email *

First, what is your name? *

Thanks! Where do you work? *

BCP

BHS

BMS

Lincoln

Paddock

Stoddard

Other:

Great! What is your primary job? *

Teacher

Support professional (para)

Clerical (secretary)

Administrator (principal)

Health professional (nurse, counselor, therapist)

Grounds/janitorial

Other:

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