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Please complete the form below to be contacted by At Ease for support.

    Preferred method of contact:

    May we leave a message on your phone?



    Are you an active first responder?


    Who are you seeking counseling services for?

    If you are seeking services for a family member, are they a minor (under 18 yrs. old)?

    Would you prefer to see a male or female counselor?

    MaleFemaleNo Preference

    Would you prefer in-person or telehealth counseling?

    In-PersonTelehealthEither

    Have you OR do you plan on filing a worker's compensation claim?

    Please note that an At Ease Support person may elect to call you for further information if needed. We will do our best to get you placed with a counselor, as soon as possible. If the form above was complete with no follow-up questions, your next contact will be directly with the counselor. Thank you for choosing At Ease. We are committed to helping Keep YOU Strong. By submitting this form you agree you have read and consent to 911 AEI’s Notice of Privacy Practices.

    Prefer to call? Please dial 888 AT EASE 4 (888-283-2734) or tap the GET SUPPORT button below from your device.

    You may be experiencing trauma-related stress injuries if you are struggling with any the following:

    Marital & Family Problems

    Stress/Burnout

    Anger Management

    Separation/Divorce

    Child/Adolescent Issues

    Parenting Challenges

    Grief/Bereavement

    Depression

    Post Traumatic Stress

    Substance Abuse

    Child/Spouse Abuse

    Retirement Concerns

    Career Concerns

    Critical Incident/Trauma

    Financial Issues

    Relationship Concerns

    Anxiety/Panic Attacks

    Nightmares

    911AEI does not provide a suicide hotline. If you are experiencing suicidal thoughts or an emergency please call your local emergency number 9-1-1 or The National Suicide Prevention Lifeline 

    911AEI is funded through the generous donations of the communities we serve, so we are not able to take clients who are involved with or expect to be involved in litigation, worker’s compensation or other legal cases. We appreciate your understanding.

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