.

Employee Consent Statement

Before submitting a management referral for your employee, please ensure that you have read the following consent statement to your employees

I confirm that I understand and consent to the personal details contained within this form being referred to Health Assured for the purpose of accessing EAP services. I have read and understood the FAQs and I acknowledge and consent for the referring manager to be informed if:

Support has been put in place by Health Assured
Support has been declined or deemed unsuitable
Health Assured have been unable to make contact with me on the contact details provided

Consent statement

Before proceeding with your referral, please ensure that you have gained explicit consent statement from your employee:
Health Assured is committed to the protection of client data and transparent use of our services. This referral form must not be completed without the individuals express consent to do so. Full details of how Health Assured handle data are available in our privacy notice –

www.healthassuredeap.co.uk/privacy-policy

Referrer First Name:

Referrer Last Name:

Referrer Email Address:

Company Name:

Referral Type

I confirm I have gained consent

I confirm I have read the guidance notes, FAQs and understand the process