Psychological Health and Safety Foundation Information Request Form

BUSINESS INFORMATION
Request Date:*
Organization Name:*
Your Name:*
Your Position/Title:*
Office Address:*
Preferred Contact Method:*
- Phone
- Email
If Phone, Preferred Call Back Time(s):
Type of Message Preferred:*
- Detailed
- Discreet
- None
Phone:*
Alternate Phone:
Email:*
Business Industry Type:*
Number of Employees:*
Business Website:*
SESSION INFORMATION
Requested Length of Session:*
- 60 minutes
- 90 minutes
Session Audience:*
E.g. managers, leaders, employees, etc.
Preferred Date(s) of Session Delivery:*
Requires a minimum of two weeks advance notice
Notes:
NEXT STEPS
1. You’ll be contacted by the session provider within two business days to schedule and plan for the session.
2. After the session is completed, you’ll receive a link to an evaluation survey.
3. You’ll receive an invoice from Arete within 45 days following the completion of the session (payment due upon receipt). You can pay for your session by any of the following:

• Cheque payable to Arete Human Resources Inc.,
• Electronic funds transfer (must note the account number on the Arete invoice), or
• Interac e-Transfer to payable@aretehr.com.

BUSINESS INFORMATION