Get Eap Provider Application/agreement

Completing the EAP provider application/agreement online is a straightforward process. This guide offers clear instructions on how to fill out each section of the form, ensuring that you provide all necessary information successfully.

Follow the steps to complete your application online.

1. Press the ‘Get Form’ button to access the EAP provider application/agreement and open it for editing.
2. Begin with the applicant information section. Fill in your name, Social Security number (required), degree, date of birth (also required), phone number, fax number, and email address (required). Make sure to enter these details accurately.
3. Provide your mailing address, including street address, city/state, and zip code. Also include your cell phone number for communication purposes.
4. In the practice location section, input the address where clients will be seen. Indicate whether this location is a personal residence by checking 'yes' or 'no'. Include the city/state, zip code, and a phone number that clients can use to reach you.
5. If you have an additional location, fill out the corresponding fields as you did for the primary practice location, specifying if this too is a personal residence.
6. Complete the additional information section by answering whether your office is wheelchair accessible, if public transportation is available nearby, and if you are bilingual, listing the languages you speak.
7. In the specialty information section, check any relevant boxes that describe your areas of expertise or specializations in clinical practice.
8. Enter your legal and background information honestly, answering whether you have experienced any licensing or insurance issues. If applicable, enclose an explanation on a separate sheet.
9. Affirm that the statements you provided are true and sign and date the application.
10. Read through the EAP provider agreement before signing to ensure all details are correct. Provide your signature and today's date.
11. Finally, digitally save your changes, download the completed form, or share it as needed according to your process.

Complete your EAP provider application/agreement online today!