Dear Provider,

Thank you for your interest in FEI Behavioral Health, Inc. We are always looking for quality groups and individuals to enhance our network.  Please use this webpage to download our application materials and print this page to use as a checklist. 

If you meet our provider requirements, please download and complete the following forms; which includes a description of our provider requirements, an Affiliate Application and Clinician Profile, a W-9 tax form and optional specialty applications for substance abuse, trauma and workplace training and seminars.  Clinicians that work with organizations that are already FEI affiliates only have to complete a clinician profile and submit resumes and copies of licenses and certifications.

All forms are available in MS-Word Format or Adobe PDF (Get Adobe Reader Free).

Click on the icon to download the form or download all of the forms in one file (click here).

Please complete as indicated and return to the attention of  the “Network Operations” with the following documentation:   Resumes, professional licenses/certifications and malpractice insurance. Applications can be mailed, faxed or emailed (please include attachments).  Applications must also include a brief description of EAP experience as well as the ability to assess, but not necessarily treat, substance abuse; if not noted in resume.

 Should you have any questions about this material, contact us at 800-782-1948,  or email us @ pr@feinet.com. 

Again, thank you for your interest in working with FEI and we look forward to hearing from you.