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Mental Health Awareness Month
Personal Story Submission Form
Thank you for sharing your story. Please take a minute to complete this short submission form.
Please complete and submit by
May 31, 2022
.
1.
Your Name:
First name:
Last name:
2.
Your e-mail address:
3.
Please indicate if you are:
Primary HealthFlex participant
Spouse covered by HealthFlex
Dependent covered by HealthFlex
4.
Conference or Employer Name:
5.
What HealthFlex program(s) have been helpful to you in supporting your emotional well-being?
Employee Assistance Program
Talkspace through the Employee Assistance Program
Virgin Pulse Health Coaching
MDLIVE Behavioral Health
Working with a provider through your behavioral health benefits
Other (please specify)
6.
Will you allow Wespath Benefits and Investments to share your story? It could be used in or posted on any medium, including but not limited to, the Virgin Pulse website, Wespath print publications, social media accounts and websites, for any purpose that Wespath and those acting pursuant to its authority deem appropriate, including promotional or advertising efforts. If you answer “Yes,” you may be asked to sign a release form in the future.
Yes
No
