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Employee Assistance & Counseling Center

New Client Instructions & Forms

Select the appropriate link below to submit intake paperwork online. Paperwork should be completed by the individual seeking counseling; parents/guardians should complete Intake Form for children age 13 and under.

Attention, UAB St. Vincent’s employees: Click here for information on your EAP provider.

EACC HIPAA Privacy Statement

If this is an emergency...

If this is an emergency, defined as suicidal or homicidal thoughts, abuse and/or domestic violence, please call 911 or one of the numbers below. Or call the EACC front desk at 205-934-2281 during regular business hours to speak with a counselor. You can also go into any Emergency Room if you are feeling suicidal and seek assistance.

  • Birmingham Crisis Center: 205-323-7777
  • 24hr Suicide Prevention Hotline: 1-800-273-8255
  • 24hr National Hopeline Network: 1-800-784-2433
  • Crisis Text Line: Text “UAB” to 741741
  • Alabama Domestic Violence Hotline: 1-800-650-6522


Intake Forms

Individual Intake Form
Couples/Families Intake Form

All family members must complete separate paperwork.

Children Under 14 Intake Form
Ages 14-19 Intake Form
Financial/Group Counseling Intake Form
One-At-A-Time Therapy Intake Form
Life Coaching Intake Form
Case Management Intake Form
Returning Client Intake Form

Use to update personal information or if you have not spoken to an EACC counselor in the previous six months. If returning after a year, complete the regular intake form.

Release of Information Form
TeleHealth Informed Consent