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  • Please select all that you would like to apply for:
  • Provider Information

  • Optional Demographic Information

    Our clients often ask for a provider that meets specific demographics within the following categories. Please note, that your response to the below is voluntary and your response, or lack of response, will not affect your application being approved or denied.

  • Languages
  • Practice Information

  • Business Attributes
  • Practice Primary EAP Contact Person
  • Provider Experience

  • Experience in Specialty Areas
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  • Provider License Information

    Requirement: FEI Affiliates must have independent mental health licensure to practice within their state and are not under any type of supervision.
  • Professional Liability Insurance

    Requirement: FEI affiliates must hold coverage at a minimum of $1 million per occurrence and $3 million per aggregate
  • EAP Experience

    Requirement: FEI affiliates must have at least 1 year of EAP specific experience to qualify for our network.
  • Please list EAPs and insurances panels that you currently provide, or in the past have provided services for.
  • Substance Abuse Specialist (optional)

    Substance Abuse Specialists skills and expertise are utilized in the employer mandated referral process, when substance abuse is involved.
  • As a Substance Abuse Specialist, I meet the criteria below and have the ability to demonstrate the following:

  • Military and Veteran Specialist (optional)

    FEI is in an excellent position to respond in a proactive manner to the needs of this special population. One part of that response involves identifying employees and family members affected by either their own, or a family member’s military service. Those identified complete an assessment tailored to issues specific to military personnel, and are referred to a provider in FEI ’s network who has the knowledge, skills and expertise to respond to the unique needs of military and veteran family needs. As a Military and Veteran Specialist, I am able to demonstrate the following:
  • Trauma Specialist Application: Critical Incident Stress Debriefing Response Experience

  • (i.e., AAETS, FAA, HRM, ICISF, NOVA, Red Cross, other certification)
  • Crisis Responder Application

    Requirement: FEI Crisis Responder training is required (at some point) for all crisis responder roles.
  • Training Specialist Application: Training Experience

  • Please select the types of audiences for whom you have previously trained/presented (Hold CTRL to select all that apply)
  • Please select the technological areas that you have had experience with (Hold CTRL to select all that apply).
  • FEI Behavioral Health offers the following seminars to our clients. These seminars typically run between 45-60 minutes in length. Please select the topics that you have had experience presenting on. (Hold CTRL to select all that apply)
  • FEI Behavioral Health offers the following seminars to the leadership groups of our clients. These sessions can run anywhere from a couple of hours to an all-day session, depending on the needs of the client. Please select the topics that you have had experience presenting on. (Hold CTRL to select all that apply)
  • References

  • Reference 1
  • Reference 2
  • Reference 3
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  • Documents

    In order to process your application, please upload, fax to: 414-359-6519 or e-mail to network@feinet.com, the following documents:
  • Max. file size: 512 MB.
  • Max. file size: 512 MB.
  • Max. file size: 512 MB.
  • Max. file size: 512 MB.
  • Max. file size: 512 MB.
  • Max. file size: 512 MB.
  • Max. file size: 512 MB.
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  • Agreement and Electronic Signature

  • My electronic signature and submission certifies the following:

  • I understand and will comply with all FEI requirements for designation as an EAP Affiliate. Some of these requirements include:

    • Offer of an appointment within 2 business days for routine appointments.
    • Clients at least 5 years of age (while I may not specialize in working with children, I will provide broad EAP assessment and referral, and I may choose to require the participation of a child’s parent(s) in the session).
  • By your signature below, you indicate your understanding of, and agreement with the following:

    I hereby certify that all the responses and information provided pursuant to the above are complete, true and correct, to the best of my knowledge. If approved as a FEI Crisis Responder, I agree to utilize any FEI standard materials according to their intended use, and will not release them further without written authorization from FEI Behavioral Health. I understand that I am representing FEI Behavioral Health whenever I am responding to a crisis activation.

  • By your signature below, you indicate your understanding of, and agreement with the following:

    I hereby certify that all the responses and information provided pursuant to the above are complete, true and correct, to the best of my knowledge. If approved as a FEI Trauma Specialist, I agree to utilize any FEI standard materials according to their intended use, and will not release them further without written authorization from FEI Behavioral Health. I understand that I am representing FEI Behavioral Health whenever I am responding to a critical incident stress debriefing on their behalf.

  • By your signature below, you indicate your understanding of, and agreement with the following:

    I hereby certify that all the responses and information provided pursuant to the above are complete, true and correct, to the best of my knowledge. I agree that, if approved as a FEI Trainer, I will implement training programs for FEI and only with FEI approval. I agree to utilize any FEI standard training materials according to their intended use and will not release them further without written authorization from FEI Behavioral Health. I understand that I am representing FEI Behavioral Health whenever I am implementing a FEI Training Program.

  • This field is for validation purposes and should be left unchanged.
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FEI has a 40-year history in enhancing workforce resiliency by offering a full spectrum of solutions, from EAP and organizational development to workplace violence prevention and crisis management.

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