By submitting this information electronically you are aware that it can be intercepted in transmission or misdirected. Your use of this intake platform to communicate your protected health information indicates that you acknowledge and accept the possible risks associated with such communication. We will respond briefly via email or telephone within three business days.

Please do not send emergency information via this platform. If you are in crisis call 1-855-278-4204 or text RENEW to 741741.

If you have any questions or would prefer an immediate response, please contact Employee Assistance Program directly at (408) 241-7772.