Client paperwork

Thank you for serving as an EAP affiliate

At the time of each client referral, we will send you the following paperwork, pre-filled with client information on the forms. If you do not receive the client paperwork packet by the time the client calls to schedule, please call 800-236-3231 and ask to have the paperwork re-sent.

Please see our Client Paperwork Instructions [PDF] for more information.

Standard paperwork packet

To promptly reimburse you for your services and communicate EAP utilization to our contracted companies, we ask that you submit billing paperwork within 30 days of each session.

Clinical assessment paperwork

The following paperwork can be used as a tool to gather client information at the first session. This information is a part of the client's clinical record, but does not need to be returned to our EAP unless the client's clinical record is requested.

For more detailed information on our Supervisory Referral process, please download the Supervisory Referral Guidelines [PDF].

Confidentiality and compliance with HIPAA

In accordance with our EAP Affiliate agreement, we ask that you ensure all client information is treated as confidential and protected by the Health Insurance Portability and Accountability Act (HIPAA). We ask that you offer a copy of our HIPAA form to all new EAP clients.

If a client would like a copy of his/her record for personal use or to be sent to a third party, we require the General Release of Information form be filled out and returned to us by fax: 414-760-5418.

If a client is a supervisory referral or if the client requests communication between our EAP and their employer, we require the Release of Information to Employer form be filled out and returned to us by fax: 414-760-5418.