EAP Forms

Clinician Application Forms

• Apply to the UBH Clinician Network
  
• Clinician Add/Change Forms

Benefit Transition Notification Form

• Benefit Transition Notification

Claim Forms

• UBH EAP Claim form
  
• UBH EAP Member Statement of Understanding

Sample Forms and Letters

• Sample Patient Financial Responsibility Form


• Consent for Release of Confidential Information Form Sample


• Client Information and Office Policies Statement - Informed Consent Sample

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