LifeMatters

If you are an eligible member seeking services, you can email a LifeMatters counselor by clicking here. Your online request will be responded to within 3 business days. If you require immediate assistance, please contact our 24/7 Care Center by calling 1-800-634-6433

We offer a variety of program designs and pricing formats. Please fill out the form below and click the "submit" button to request a rate quotation. We will respond within 48 hours of receiving your request.

I am interested in the following services:

LifeMatters (EAP and work/life programs)
	Do you currently have an EAP and/or work/life program? Yes No What has prompted you to request a quote for services? How many employees are you planning to cover under the program? What is your approximate turnover rate? *Do you have employees covered under the Department of Transportation (DOT)? Yes No How many? What EAP and work/life services are important for your organization? What type of program are you looking for?
WellMatters (Wellness services)
	Do you currently have a wellness program? Yes No *How many employees are you planning to cover under the program? What has prompted you to request a quote for services? Are there specific wellness services that you are interested in? If yes, please list
BusinessMatters (Services for HR and managers)
	Which of the below services would you like information on? Trauma Response Leadership Coaching Short Term Disability Case Management Ethics Compliance Hotline Retirement Consultation
Training & Development
	How many training hours would you like included per year? Do you prefer on-site training or virtual training via the Web? On-site Virtual Both How many employees/managers are you interested in training? Do you prefer on-site training or virtual training via the Web? On-site Virtual Both How many site locations will require training? When would you like to conduct the training? Are there multiple shifts that need to be accommodated? Yes No Is there a specific topic(s) that you are interested in?
CarePartners

Disaster Management Services

ExactHire

ExitTrends

Is there anything else we should know before preparing a rate quote form?

Contact Information

*Company Name

*Contact Name

Title

*Email

*Telephone Number

*Address

*City

*State

*Zip

*Do you have employees in the state of California?	Yes No

*Are you a broker/consultant representing a client?	Yes No

*Client Company Name