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* 1. The EAP management referral process was helpful in my job as a supervisor/manager.

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* 2. Given the limits of confidentiality, the EAP case manager provided me with on-going feedback regarding this employee's participation and compliance.

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* 3. The EAP supervisor referral process was an efficient and straightforward process.

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* 4. Is this person still employed by your organization?

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* 5. Reason for referral. Check all that apply.

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* 6. Are there any additional comments you wish to make?

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* 7. Please list your name (Referring supervisor)

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* 8. Please list the name of your company.

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* 9. Please select the name of the clinician that worked with you.

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* 10. Case Number, Employee's Last Name

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