TELUS Health

Welcome to Telus Health

We are pleased to offer a confidential alternative way to contact our Internal Employee and Family Assistance Program services. Please note that Internal EFAP services are short term based and oriented towards solutions.
Disclaimer

Telus Health is committed to the highest standard of privacy, confidentiality, data security, and complies with the most stringent requirements of managing private and confidential information in the United states.

If you select an Online service or the Fitness Lift service, and wish to remain anonymous, we suggest you use an email address that does not include your name.


  * Marks required fields

Risk Assessment

  * At the moment, do you have reason to believe that yours or someone else’s safety is at risk?

That would include thoughts of harm to yourself or others.

Yes  No 
Self Assessment

To assist us in responding appropriately to your request please assess yourself on the following scales:
  * Stress Level  Low  Moderate  High 
  * Degree of Urgency  Low  Moderate  High  Urgent 

 Profile
* First Name 
* Last Name 
* Date of Birth (MM/DD/YYYY) 
* Gender 
* Country  United States
* State/Territory 
* Zip code 
* Are you the TELUS Employee?  Yes  No 
* TELUS Employee Name 
* TELUS Employee Date of Birth (MM/DD/YYYY) 
* Your Relationship to the TELUS Employee 
 Contact Information
* Primary Phone Number  
**Please note this will be the number given to providers for call backs when booking services.
* Area Code * Number EXT
     
* Primary Phone Type    Cell  Work  Home 
* May we leave a message?    Yes  No
Secondary Telephone number (Optional) 
Area Code Number EXT
     
Secondary Phone type    Cell  Work  Home 
May we leave a message?    Yes  No 
* Email Address 
* Preferred Method of Contact  Phone  Email 
* Preferred Language of Correspondence  English
 Request Details
* Please select a Service 
* Modality 
* Presenting Issue 
* Modality 
* Request is for 
* Modality 
* Modality 
* Request is for 
* Presenting Issue 
* Modality 
* Modality 
* Presenting Issue 
* Modality 
* Presenting Issue 
* Modality 
* Modality 
* Request is for 
* Presenting Issue 
* Request is for 
* Request is for 
* Please provide the first and last name of your spouse/partner 
* First Name * Last Name
* Please provide the date of birth of your spouse/partner (MM/DD/YYYY) 
Family Members * First Name * Last Name * Relationship * Date of Birth (MM/DD/YYYY)
* Family Member 1        
  Family Member 2        
  Family Member 3        
  Family Member 4        
* Please provide the first and last name, relationship to you, and dates of birth for all those that will be attending the sessions  
First Name Last Name Relationship Date of Birth (MM/DD/YYYY)
* * * *
       
* Please indicate if you have a gender preference when it comes to the Counselor assigned to your request  
Please indicate if you have preferences for the counselor assigned

Please note - Although we cannot guarantee to find an exact match, we will verify if such a match is possible and assign relative to what is possible. Also, specific requests may delay assignment, due to shortage of resources.
* Preferred Days and Hours for Appointments 
*

Callback windows should account for the elapse of 24 business hours from the date and time of request submission.
* Date (MM/DD/YYYY) * Start Time * FinishTime
* Window 1 
* Window 2 
* Window 3 
* Please select a time zone 
* Preferred location for service(s): Please provide details such as city, town or area to help us source the closest service(s) location  
*
 
Additional Service Requested (Optional) 
* Modality 
* Presenting Issue  
* Modality 
* Request is for 
* Modality 
* Modality 
* Request is for 
* Presenting Issue 
* Modality 
* Modality 
* Presenting Issue 
* Modality 
* Presenting Issue 
* Modality 
* Modality 
* Request is for 
* Presenting Issue 
* Request is for 
* Request is for 
* Please provide the first and last name of your spouse/partner 
* First Name * Last Name
* Please provide the date of birth of your spouse/partner (MM/DD/YYYY) 
Family Members * First Name * Last Name * Relationship * Date of Birth (MM/DD/YYYY)
* Family Member 1        
  Family Member 2        
  Family Member 3        
  Family Member 4        
* Please provide the first and last name, relationship to you, and dates of birth for all those that will be attending the sessions  
First Name Last Name Relationship Birth date
* * * *
       
* Please indicate if you have a gender preference when it comes to the Counselor assigned to your request  
Please indicate if you have preferences for the counselor assigned

Please note - Although we cannot guarantee to find an exact match, we will verify if such a match is possible and assign relative to what is possible. Also, specific requests may delay assignment, due to shortage of resources.
* Preferred Days and Hours for Appointments 
*

Callback windows should account for the elapse of 24 business hours from the date and time of request submission.
* Date (MM/DD/YYYY) * Start Time * FinishTime
* Window 1 
* Window 2 
* Window 3 
* Please select a time zone 
* Preferred location for service(s): Please provide details such as city, town or area to help us source the closest service(s) location  
*