Request a Proposal
Date Quote Needed:
Submitted by:
Firm:
Address:
Address 2:
City:
State:
Postal Code:
Email:
Telephone:
1. Prospect Name:
2. Corporate Location:
3. What States are employees located? [approximate number of employees by state, if available]
4. General Description of Business:
5. Has an EAP been in place? [if NO, proceed to question 6] Yes No
5a. If yes, how long?
5b. Name of current EAP vendor?
5c. Can EAP Preferred receive a copy of the current EAP vendor's List of Services/Scope of Work [not fees]? If so, please attach.
5d. Has current EAP vendor submitted annual program utilization reports? If so, please attach full copies of full reports for the last two years.
5e. Does the current vendor include specific services that the prospect finds desirable?
5f. Does the current vendor not include specific services that the prospect would find desirable?
6. Indicate number of sessions preferred Pre-paid Counseling Sessions:
7. There are optional elements to our standard EAP, please indicate if you wish them included in our fee or made available on a fee-for-service [FFS] basis, check one option;
7a. Hard copies of Communication Materials [electronic copies are standard; refer to our List of EAP Services]:
Include FFS Other
7b. Hard copies of Supervisor Training Guide [electronic copies are standard; refer to our List of EAP Services]:
Include FFS Other
7c. Onsite Orientation /Supervisor Training:
Include FFS Other
7d. Onsite Critical Incident Response:
Include FFS Other
7e. Onsite Health & Benefit Fair & Brown Bag Seminars:
Include FFS Other
7f. Other Services, please describe and indicate fee preference [included in EAP Preferred's fee or FFS]:
8. Are commission or other fees to be include in EAP Preferred's fees [if so at what percentage or amount, and for what length of time]?
9. Other conditions that would affect this proposal or the provision of services?