Provider Forms

The following forms are for use by Employee & Family Resources EAP affiliate providers. They are in PDF format and require Adobe Acrobat Reader to view. You are welcome to print any of these forms for EFR EAP use. Instructions for submission are found on the forms.

Credentialing — For use by those who have been approved by EFR to join the affiliate network.

This is linked to a PDF Document EAP Affiliate Credentialing Part I: Administrative
This is linked to a PDF Document EAP Affiliate Credentialing Part II: Clinical

If you wish to inquire about joining the network please refer to "Becoming a Provider" for an application.

EAP Documents — Forms required for reimbursement for EAP services.

This is linked to a PDF Document EAP Case Assessment
This is linked to a PDF Document EAP Case Billing
This is linked to a PDF Document EAP Case Closing
This is linked to a PDF Document EAP Case Data

Other EAP Forms — To be used as needed.

This is linked to a PDF Document Guide to EAP Affiliate Forms
This is linked to a PDF Document Notice of Privacy Practices
This is linked to a PDF Document Client Grievance Form
This is linked to a PDF Document Written Consent to Disclose Confidential Information
This is linked to a PDF Document Written Consent to Obtain Confidential Information

If you do not have Acrobat Reader installed on your computer, you can download it for free at www.adobe.com.

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