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Counselor Match Request

Employees of AAA member organizations are invited to complete the brief form below or call 847-209-8208 in order to request to be matched with an EMS-competent counselor in their local area. This replaces the previous EAP program hosted by Lifeworks.

The matching process is managed by a licensed counselor with extensive EMS experience. This professional will confirm receipt of your request for a match by phone or email within one business day. Matches will be communicated by email or phone within seven business days. Please DO NOT include any confidential medical information in the form below. If you are experiencing thoughts of self-harm, please call 911 immediately. 

While the cost of the matching process is covered by AAA, all counselor fees, deductibles, and co-pays are the responsibility of the patient.

Counselor Match Request for AAA Members

  • Name of the individual requesting a counselor match
  • Counseling requests WILL NOT be shared with your employer. The name of your employer is collected only to ensure eligibility for participation in the counselor match program.
  • For correspondence with the counseling match program
  • I understand that the American Ambulance Association covers ONLY the cost of matching me with a counselor. I understand that any copays, fees, or deductibles charged by the counselor that are not covered by insurance are my responsibility. I understand that it is my responsibility to validate insurance coverage before my first visit.
  • For correspondence with the counseling match program
  • Please provide your home address so that we can attempt to locate a counselor in your area.
  • If you would like the counselor match program to attempt to match you with a provider who accepts your insurance, please provide the name of your insurance provider and the specific plan you have. For example "Carefirst Blue Cross Blue Shield BlueChoice HMO Silver" or "Kaiser Permanente - Bronze 60 HMO" DO NOT provide your specific ID number or group number as these are confidential. ******Please note that it is your sole responsibility to verify coverage after the match, before your first appointment. All fees, copays, and deductibles are the responsibility of the patient.******
  • Are there particular issues you are seeking help with? (OPTIONAL)
  • Please share with us anything else you think might be important. Is there a particular incident this request is in response to? Any questions or concerns?
  • This field is for validation purposes and should be left unchanged.

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