EAPPP Listing

EAPPP?

EAPs in Private Practice Understand:

the need for timely appointments
the management referral process.
the importance of communication and updates
there are multiple clients being served
the dynamics of the workplace

Refer to one and see what I mean

Get yourself listed! Once your listed, your services will be announced in our next email resource mailing list. These are professionals who want to know!

If you are an EAP professional, or treatment provider please fill out the form below.

Professional Listing- includes:

Name, Degrees and Certifications
Address of private practice
Phone numbers- work, cell, fax
Email address
Place of EAP Business
Specialties
Website linkage
Provider panel listings
Statement about services
Graphical presentation
Photo (optional)

See examples

Listing Fees

	Individuals	Groups	Multi-service
Professional Listing	$45.00	$80.00	$150.00

These fees are for the first year and include set up charges. Renewal only costs $25.00 per year for all services.

Individuals are defined as sole practitioners.

Groups are defined as 3 or more practitioners.

Multi-service is defined as an agency providing outpt., inpt., EAP or other mental health services.

To get Listed, Fill in the form

This form is used for the Professional Listing.

Name(s)/Degree(s)/Cert.(s)
Address of private practice or additional services
City
State
Zip
County
Phone
Fax
Cell
Beeper
Email
Where have you been an EAP?
3 Specialties per practitioner
License
Web Site(s)
Provider panels you belong to
Statement about your services or self (under 50 characters)
Licenses, accreditations
Payment If you would like to pay using PayPal, skip this payment section and click on the link that appears after you send in this form.
Name on Card
Credit card #
Exp. date
Billing address (if different than above)
Address
City
State/Province
ZIP
Country
I prefer pay by check
Send to: Robert Douglas and Associates 2002 Sunset Ave. Ocean, NJ 07712
Or order over the phone: 732-988-5141

Payment services by: Wells Fargo