Online Request Form for Mass General Brigham Assistance Program Child Care Search Request
If you would like to explore childcare options with an EAP Consultant, please call 866-724-4327 for an appointment. If you are interested in a childcare search only, please fill out this form. A Mass General Brigham EAP Work and Life specialist will reach out to you by phone to gather information about your childcare needs. You will receive up to 3 childcare referrals. Please note your childcare search will take up to 2-5 business days. If your situation is urgent, please call us.
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First Name
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Last Name
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Employee ID
User Name
Email
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Date of Birth
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Date of Hire
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April 2025
Sun
Mon
Tue
Wed
Thu
Fri
Sat
14
30
31
1
2
3
4
5
15
6
7
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9
10
11
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16
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Phone Number
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Mass General Brigham entity for whom you work
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Phone Type
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How did you hear about the EAP?
Ethnic Background
Weekly Budget
Dependent Child(ren) Information: Specify the age of your child when they will be attending childcare.
Age
Age 2
Age 3
Age 4
Family Day Care
Family Day Care
Family Day Care 2
Family Day Care 2
Family Day Care 3
Family Day Care 3
Family Day Care 4
Family Day Care 4
Center Based Care
Center Based Care
Center Based Care 2
Center Based Care 2
Center Based Care 3
Center Based Care 3
Center Based Care 4
Center Based Care 4
Preschool Program
Preschool Program
Preschool Program 2
Preschool Program 2
Preschool Program 3
Preschool Program 3
Preschool Program 4
Preschool Program 4
Nanny
Nanny
Nanny 2
Nanny 2
Nanny 3
Nanny 3
Nanny 4
Nanny 4
Best times to reach you by phone (we will make up to three attempts to reach you)
Additional information that will assist us in providing childcare referrals.
Consent Full Name
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