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
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.