Follow the steps to complete the OMNI Behavioral Health EFH Application online.

1. Press the ‘Get Form’ button to access the OMNI Behavioral Health EFH Application form and open it for editing.
2. Begin with the applicant details section. Enter your full name, including any aliases or maiden names. Provide your date of birth and your social security number.
3. Fill out the contact information fields. Include your address, city, state, zip code, home phone number, work phone number, cell phone number, and email address.
4. In the preferred method of contact section, select your preferred ways of communication by checking the relevant boxes.
5. Describe how you heard about the OMNI program by checking the applicable sources.
6. Complete the household information section, listing all household members and their relation to you.
7. Answer questions regarding pets and smoking in your home, providing details where necessary.
8. Outline your support system by indicating the family members who support your decision to become an EFH provider and their willingness to undergo background checks.
9. Rate your comfort levels with various client characteristics and behaviors on a scale of 1-5, ensuring to answer all questions honestly.
10. Detail your relationship status and provide insight into how decisions are made in your relationship.
11. Reflect on your strengths, weaknesses, and personality traits in the background section.
12. Answer questions regarding your health, past mental health care, and any issues that may affect your ability to provide care.
13. Provide information about your vehicle, including its insurance status, and your willingness to provide transportation.
14. List three personal references who can vouch for you.
15. Review all completed sections for accuracy. Once satisfied, you can save changes, download, print, or share the completed application.

Complete your OMNI Behavioral Health EFH Application online today to take the first step towards becoming a provider.