Affiliate 8th Session Review
The Village Business Institute's Employee Assistance Program (EAP) is a voluntary program that offers free and confidential assessments, short-term, non-diagnostic counseling, referrals, and follow-up services to employees and their household members who have personal and/or work-related problems.


Please complete the following regarding your client. Decisions for approval or denial of requests are based on the information given by you. Forms that are not completed in full may result in denial of requested sessions. Sessions that occurred prior to obtaining authorization will not be approved.
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Email *
Authorization Number *
Presenting Issue(s) *
Expected number of session to complete service? (Max of 4) *
In detail, please explain the reason(s) you are requesting more sessions. *
Counselor has reviewed with the above-named client the short-term nature of services, options for continued services, possible length of continuing services, and an action plan has been created and shared with client. *
Steps for completion of services (action plan): *
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