Purpose and Scope of PAC:

•  I understand that my employer has requested I attend a Proactive Annual Check-in (PAC). This is a non-evaluative, consultative meeting designed to provide first responders with psychological support and education to promote mental health. Participation does not require a specific problem; it is a proactive wellness service.

•  The PAC provides an opportunity to talk to a mental health professional in a confidential setting without initiating a medical record. The PAC is not therapy and not a fitness-for-duty evaluation. It is a consultative service focused on personal and professional wellness and is intended as a proactive “check-in” rather than a "check-up." Discussions may address coping strategies, self-care techniques, and general wellness concerns.

•  The meeting lasts approximately 45 minutes and may be attended virtually or in person (with some providers).

Confidentiality and Voluntary Participation:

•  I understand that I am not required to make specific disclosures, and my level of engagement is mine to control. While my attendance may be required, my level of participation is voluntary. The provider will not pry or force disclosures of personal information.

•  Information shared during the PAC is highly confidential. My employer will only receive confirmation of my attendance. Exceptions to confidentiality occur only in extreme circumstances when required by law, including imminent and unmitigated risk of suicide or homicide, child or dependent abuse/neglect, and court orders requiring disclosure. In situations requiring a breach of confidentiality, my PAC provider will attempt to discuss the matter with me beforehand.

•  Any quality improvement or research data collected will be de-identified.

Recommendations and Follow-Up Options:

•  Personalized recommendations for improving or maintaining my wellness will only be provided to me, not my employer or any other party.

•  If counseling or other services are suggested, recommendations may be provided at my request. Proactive check-ins are scheduled to occur once a year. If I believe I would benefit from additional appointments, I may use my health insurance benefits, EAP services, or other services available to me.

Scheduling, Attendance, and Compensation:

• This service is free to me, does not involve insurance billing. Time spent at the PAC is considered work time and will be compensated based on my agency’s policy. I will coordinate with my supervisor regarding appointment time and coverage of duties.

•  If I cannot attend, I will notify the provider via email or use the cancel/reschedule options in appointment reminders.

Ready to Schedule a PAC?:

•  IF YOU HAVE READ, UNDERSTAND, AND AGREE TO THE TERMS OF THE ABOVE INFORMED CONSENT STATEMENT USE THE LINKS BELOW TO SCHEDULE A PROACTIVE ANNUAL CHECK-IN.

• QUESTIONS? Email Us