Provider Forms & Information 

Participating Provider Forms

Participating Provider Step-by-Step Procedures (explains referral WSEAP process) 

WSEAP Statement of Understanding form (this must be signed by every EAP patient)

Sample EAP HCFA 1500 Claim Form (please use this as a guide for all claims)

WSEAP Referral & Invoice Form (use only if provider cannot use HCFA 1500 form)

New Provider Application

Client Status Report (completed by therapist after any supervisor referral session)

Employer Group Supervisory Referral Paperwork

Supervisory Referral Step-by-Step Process

Supervisory Referral Information

Supervisory Referral Form

Informed Consent Form

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