Please help us improve our program by answering the following questions.

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* 1. Please rate the following items:

  Strongly Disagree Disagree Agree Strongly Agree
EAP helped me with my concern.
EAP offered a timely appointment (within 5 business days).
I would recommend EAP to a co-worker.
My job performance improved after EAP services.
My physical well-being improved after EAP services.
My emotional health improved after EAP services.
My personal relationships improved after EAP services.
I feel the EAP is a valuable benefit offered by my company.
My counselor was helpful and treated me with respect.

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* 2. Prior to coming to EAP:

  Strongly Disagree Disagree Agree Strongly Agree
I was missing work.
I was late for work or leaving early.
My problem required me to be on the phone, email, or internet while at work.
I was not able to enjoy my work.
My problem kept me from concentrating on my work.
I worried about completing my tasks.
I could not do my job well because of my personal problems.
I was not very satisfied with my life as a whole.
Thinking about being at work made me upset.
I was unhappy much of the time at work.
I dreaded going into work.
I often felt anxious at work.

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* 3. If EAP referred you to a treatment program, therapist or community resource, please check all that apply:

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* 4. If telehealth was used with your service, please answer the following questions about your telehealth experience.

  Strongly Disagree Disagree Agree Strongly Agree
I could clearly see the therapist during the visit.
I could clearly hear the therapist during the visit.
The telehealth visit was as good as a face-to-face visit.
The camera or other telehealth equipment DID NOT make me embarrassed or feel uncomfortable.
I would have had to miss work or school if not for the telehealth visit.
Overall, I am satisfied with my telehealth visit.

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* 5. Other Comments about EAP or a Referral Service

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