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EMPATHIA PACIFIC, INC. - EMPLOYEE ASSISTANCE PROGRAM
5234 Chesebro Road, Suite 201
Agoura Hills, CA 91301
(800) 367-7474 • Fax (818) 707-0496
Grievance Complaint Form
To: EAP Client/Enrollee:
The following is a grievance form to submit a written expression of dissatisfaction regarding any aspect of Empathia's services. This form does not have to be completed to submit a complaint. Grievances may be submitted by telephone to any of Empathia's toll-free numbers or face to face at an Empathia provider office location. Neither Empathia nor any of its providers will discriminate against a Member based on the filing of a grievance.
The Member Services Officer and Clinical Director will review and investigate all grievances. By law, all grievances must be resolved within 30 days of receipt. If a grievance is not resolved within 24 hours, the Member will receive a letter acknowledging receipt of the grievance and a letter summarizing the disposition upon resolution.
If you need help in filling this form out, please call us at 1-800-367-7474.
To email us the form, please fill out the form below.