Becoming an EAP Affiliate

Affiliate providers for Southern Hills Counseling Center should be licensed practitioners in good standing who are competent in providing general practice services. Affiliates are expected to be able to offer potential clients an appointment within 3 business days of their initial phone call. Affiliates may be asked to provide Orientation Trainings, Supervisor Trainings, and to be available for Critical Incident Stress Management de-briefings.

If your organization is interested in becoming an Affiliate provider, please have your Human Resources Director or EAP Program Coordinator contact Jessica Cooper
( This email address is being protected from spambots. You need JavaScript enabled to view it. ) at 812-482-3020. All contacts will be answered within 3 business days.

Below is a list of documents that must be completed and submitted before an Affiliate contract can be signed. Southern Hills Counseling Center does not require clinical documents to be faxed back any time during the course of treatment.

Document: EAP Ethical Affirmation

Document: W9 Form

Document: HIPAA form

Document: Billing Form

Document: Billing Form Procedures

After faxing the documents, Jessica will contact you within three (3) business days regarding your request.

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Southern Hills Counseling Center, Inc.
480 Eversman Drive
Jasper, IN 47546
(812) 482-3020