Ready To Make A Positive Impact In Peoples Lives?
Fill out the form below to join our network of EAP providers.
What EAP would you like to join? (Select All That Apply)
*You are not obligated to accept the referral and you can deny them as
they come through
What types of clients are you accepting? (Select All That Apply)
What is the minimum age of a client you will accept?
What sort of support do you offer?
Your licenses. (Select All That Apply)
Your states. (Select All That Apply)
Your specialties. (Select All That Apply)
Your profile picture
Upload a photo to one of these image sharing sites and insert the
sharable link below. If you're having trouble just email us the photo.
Your malpratice Insurance
Upload a copy of your malpractice insurance and share the link with us
below. Here are some choices for file sharing
Your Graduate Degree
Upload a copy of your degree and share the link with us below. Here
are some choices for file sharing
Your Primary License
Upload a copy of your license and share the link with us below. Here
are some choices for file sharing
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