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Client Services
If you are interested in receiving EAP services, please fill out the below form and a staff member with CKET will contact you as soon as possible. For all other questions, please fill out the Contact Us form on our Contact Us page.
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Name of person filling out this form:
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Your answer
Email Address
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Your answer
Relationship to potential client (e.g., self, case manager, FAPT Team member, etc.):
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Your answer
Phone number of person filling out this form:
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Your answer
Name, phone number & email address of parent/guardian of potential client if potential client is a minor?
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Your answer
Additional information: Why are you seeking/referring service? Do you have any questions about services?
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Your answer
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