Access Your EAP Supports. Have a question? Take a peek at our Frequently Asked Questions—we’re confident there’s an answer there for you! 1-877-412-7483 "*" indicates required fields 1Your details2Member information3Support We’re ready when you are! If you’re covered through your employer, health benefits insurer or other organization to receive support from Arcora and are looking for counselling services or other guidance—you’ve come to the right place. If you or a family member require immediate assistance, please call or text the Suicide Crisis Helpline (available 24/7/365) immediately at 988.Name* First Last Phone*Phone typeSelectCellphoneHomeWorkWork CellphoneCan we leave a detailed message at this number?* Yes No I consent to receive SMS messages from Arcora regarding my plan coverage, follow-up messages, and updates.*Users can withdraw consent at any time. Yes No Email* Address* Street Address Address Line 2 City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Note the Arcora member is the person in your family who has access to Arcora services through their employer or insurer. Are you the Arcora member?*The member would be the person in your household who has access to Arcora services through their employer or insurer. If it's you, click 'Yes'. If it's your spouse/partner/parent, click 'No'. Yes No Arcora member's name* First Last What's your relationship to the covered user?* Spouse/partner Child Employer nameEmployer name(Arcora member)Organization/insurer*Choose from the list the name of your (or your spouse's/partner/parent's) insurer/benefits organization/other provider that allows access to Arcora services.SelectChambers of Commerce Group Insurance PlanJohnston GroupLewer CanadaPayworksWawanesa LifeWestern Financial Group Insurance Solutions (WFGIS)OtherDon’t knowFirm/Division/Group/Plan numberFind this number on your group benefits card or customer account.Certificate/member numberThis is the unique identifier that will help us make sure we've got the right person, connected to the right organization and can get you the support you need as quickly as possible.We ask the next few questions for reporting purposes so that we can learn more and better serve you through our program and service offerings.What's your current job title?*How long have you been with your current employer?*Of the options below, what best defines your current employment status?* I'm working full time I'm working part time I'm working casual I'm working contract I'm on a leave Choose the type of leave that best fits your current situation from the list below.*SelectMaternity/parental leaveSick leaveShort term disabilityLong term disabilityIllness (employment insurance)Leave of absence (medical)Leave of absence (personal)Other/don't knowWhat was the last day you worked?* DD slash MM slash YYYY Because offerings can differ from one company to the next, it's possible that your solution may not give you access to all services listed below. Don't worry though, we'll be in touch if that's the case and will work with you to find the support you're looking for.Who’s in need of support?*SelectMyselfMyself and a partner (couple)My familyMy childWhat type of support are you interested in?*SelectChildcare navigation supportCounselling supportEldercare guidanceNutritional guidancePersonal financial guidancePersonal legal guidanceYour informationWhat's your birthdate?* Day Month Year What's your gender identity?*We ask this for reporting purposes so that we can learn more and better serve you through our program and service offerings.SelectFemaleMaleTransgenderGender neutralNon-binaryAgenderPangenderGenderqueerTwo-spiritThird genderOtherPrefer not to sayWhat are your pronouns?What's your marital status?We ask this for reporting purposes so that we can learn more and better serve you through our program and service offerings.SelectCommon-lawDivorcedMarriedSingleWidowNot applicablePrefer not to sayChild's informationWhat's your child's birthdate?* Day Month Year Child's name* First Last Child's gender IdentityWe ask this for reporting purposes so that we can learn more and better serve you through our program and service offerings.SelectFemaleMaleTransgenderGender neutralNon-binaryAgenderPangenderGenderqueerTwo-spiritThird genderOtherPrefer not to sayChildcare navigation supportTell us in detail about the challenges you’re facing finding childcare.* Once you click submit, we’ll email you in 1-2 business days with childcare options we think will be the best fit for you based on the information you shared (please keep an eye on your email/junk mail folder for an email with the subject: Childcare info). It will then be up to you to reach out to find out more about the options you think will work for you and your child. Counselling Consent FormBy signing below, I understand/authorize/consent to the following: Arcora counselling programs are designed as time-limited, goal-oriented mental health treatment programs using evidence-based modalities. The collection and use of necessary information to manage my case file. Necessary information includes personal information, contact notes, dates of my sessions, summary of interventions, general assessment of my progress and counselling outcomes, all of which will be collected, used and disclosed in compliance with applicable federal and provincial laws. This information is collected to ensure proper invoicing and therapeutic due diligence. There will be no disclosure of any information to my employer or other third parties that would expose my identity or reveal the content of my counselling sessions, without my written permission. In the case of counselling with family or other members, Arcora cannot be responsible for a breach of one client’s privacy by the other client. The confidential nature of my counselling will be respected unless there is a reason to believe there is a risk to myself or someone else, including a child or if the file is subpoenaed by a court of law. Arcora will only disclose the contents of my file in accordance with applicable law. Arcora staff members managing my file will store and handle all personal information as confidential and in compliance with applicable federal and provincial laws. This confidential information is held only between the Arcora Clinical Affiliate, Arcora staff members and designated business contractors and/or associates. Anonymous information related to my treatment may be used for research purposes, regarding program effectiveness, satisfaction, improving services and demonstrating impact. I may be emailed a confidential survey pertaining the above-mentioned. To ensure the best possible service and care, Arcora Clinical Affiliates may participate in Arcora staff-led clinical consultations (individual or group) regarding my treatment. In the case of group consultations, which involve other Arcora Clinical Affiliates, only non-identifying clinical information is shared. Non-identifying demographic information and access information is collected and pooled for utilization reports to insurers. Monthly invoices are provided to insurers using plan certificate numbers, or confidential file codes if billing direct to employers. Arcora Clinical Affiliates must remain neutral. They are unable to make diagnoses or recommendations about legal, medical or work-related matters based on information gathered from Arcora sessions. Arcora Clinical Affiliates cannot participate in labour relations, disability assessments or act as an expert witness in court. Clinical Affiliates cannot write reports or letters for reasons not discussed in the initial request for counselling, which may place Arcora in a conflict of interest with the employer. Submitted reports to Arcora represent a summary of the counselling sessions and are the confidential property of Arcora. I may review this summary with an Arcora staff member or obtain a copy upon request. I may report a complaint or request a different Clinical Affiliate at any time. Arcora may gather information to endeavour service provision is to my satisfaction. This consent is valid for the time that Arcora must maintain the file. Costs: The cost of sessions is covered by my assistance program. I am aware Arcora will cover one no-show/late cancellation fee per referral on my behalf, at the Arcora rate. This will count towards my total hours of allotted service on my plan and as such, cannot exceed a plan’s available hours. However, I will be responsible for the full cost of additional missed appointments and appointments changed or cancelled with less than 24 hours notice, as may be assessed by the Clinical Affiliate. This pertains to counselling under any modality, face-to-face, telephone or video. File Closure: Our counselling programs are designed as time-limited interventions rather than open ended. Files can be closed if no appointments are booked within 60 days. Arcora will endeavour to follow up with the Clinical Affiliate and client prior to file closure. Files can be re-opened if services are required later. Informed Consent: Benefits, limitations and risks of counselling have been explained to me. I have read and understand the above and have discussed any questions with the Arcora Clinical Affiliate.N/A* I agree*Is a parent/legal guardian's consent required?* Yes No Client Signature*Parent/Guardian Signature*Date* MM slash DD slash YYYY I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent allowed by applicable law.* I agreeCounselling supportAre you currently having suicidal thoughts?* Yes No If you or a family member are in immediate risk, please contact the Canada Suicide Prevention Service immediately at 1.833.456.4566 or text 45645. They’re available 24/7/365 to help. Your answer will help us make the best therapeutic match for you. Are you experiencing family violence?* Yes No If you are in immediate danger or need urgent medical support, call 9-1-1. The Government of Canada has a list of national, provincial and territorial family violence resources that can also help if you’re in need. Your answer will help us make the best therapeutic match for you. Are you seeking counselling for addiction or substance abuse?* Yes No Tell us about your addiction and/or about the substance(s) you’re currently using.Your answer will help us make the best therapeutic match for you. Tell us in detail about the challenges you’re facing.*How would you prefer to connect with a counsellor?*Select all that apply In person By video By telephone Are there any access requirements we should be aware of?What are your preferred appointment times?*Select all that apply. However, note that selecting only evenings and/or weekends may limit the professionals we can match you with. Days Evenings (5 p.m. onward) Weekends No preference Are there any other details you’d like us to consider?*Sharing preferences like counsellor gender identity, lived experiences, therapy approach/training, spiritual background, geographic location, etc. goes a long way to helping us find you an excellent counsellor match. If you have previously seen a counsellor through Arcora and would like to work with them again, let us know and share their name if you recall it. We’ll see if they’re available to support you at this time. If you’re already seeing a counsellor and are hoping to continue working with them through Arcora, share their name and contact details and we’ll reach out to see if they fulfill our requirements to work together. Once you click submit, we'll email you in 1-2 business days with the name and number of the counsellor we think will be the best fit for you based on the information you provided (please keep an eye on your email/junk mail folder for an email with the subject: Counselling Referral). It will then be up to you to reach out to them to book your first appointment at your convenience. If you find that the counsellor we've recommended isn't a good fit, please let us know right away so we can reassess and make it right. Eldercare guidanceTell us in detail about the issues you’re having with eldercare.*Note that eldercare guidance is provided by phone only.What are some call back date/time windows (including time zone) that work best for you*Note that professionals are available to connect within standard business hours, Monday-Friday. Once you click submit, a professional in the Arcora Network will be in touch by phone within 1-2 business days to get you the eldercare support you need. Nutritional guidanceTell us in detail about the kind of nutritional guidance you’re looking for.*Note that nutritional guidance is provided by phone only.What are some call back date/time windows (including time zone) that work best for you*Note that professionals are available to connect within standard business hours, Monday-Friday. Once you click submit, a professional in the Arcora Network will be in touch by phone within 1-2 business days to get you the nutritional guidance you need. Personal financial guidanceTell us in detail about the reason you’re looking for financial guidance.*Note that personal financial guidance is provided by phone only. Personal financial guidance is intended for general consultation only, so developing materials on your behalf or consulting on highly complex issues are not covered.What are some call back date/time windows (including time zone) that work best for you*Note that professionals are available to connect within standard business hours, Monday-Friday. Once you click submit, a professional in the Arcora Network will be in touch by phone within 1-2 business days to get you the financial guidance you need. Personal legal guidanceTell us in detail about the reason you’re looking for legal guidance.*Note that personal legal guidance is provided by phone only. Personal legal guidance is intended for general consultation only, so developing materials on your behalf or consulting on highly complex issues are not covered.What are some call back date/time windows (including time zone) that work best for you*Note that professionals are available to connect within standard business hours, Monday-Friday. As a condition of using this service, you hereby acknowledge and agree that (i) the service is limited to general legal information; (ii) the service does not include any legal advice or application of legal principles and judgement to your circumstances; (iii) the service does not constitute legal services; (iv) there is and will be no lawyer-client relationship between you and the lawyer (or the lawyer’s law firm as applicable); and (v) the communications are not subject to lawyer-client (solicitor-client) privilege. You should not take, or refrain from taking, any action based on this service. If you need advice about a specific legal issue, you should engage a lawyer directly. This service does not replace and is not a substitute for the advice of lawyers and other experts. Legal Guidance Consent* I agree* Once you click submit, a professional in the Arcora Network will be in touch by phone within 1-2 business days to get you the legal guidance you need. ConsentConsent I understand that all my information is kept confidential unless there’s a risk to myself, someone else or if subpoenaed by a court of law.