To become part of the IMPACT Provider Network for your area, please complete this form and return to us
Upon our receipt of your materials, a contracting packet will be sent to you for completion. Once returned you can begin to receive referrals, and you will soon notice the ease of working with IMPACT. We require very little paperwork and allow you to retain your clients after their EAP sessions are complete.
If you are new to your practice and would like to be added to an existing IMPACT group contract, please go to Current Provider - Update your profile.
We look forward to working with you. If you have any questions or concerns regarding our EAP Contract/Rates, please contact the Provider Relations Dept. at 216-292-6007 or e-mail us at email@example.com
Thank you for your interest!
Current Providers/Profile Update
If you are a CURRENT provider and need to update your data, or if you are a NEW clinician and wish to be added to an existing IMPACT group, please complete this form.
Be sure to include copies of your current license and liability insurance verification.
Return your materials to us
If you have any questions or concerns regarding our EAP Contract/Rates please contact the Provider Relations Dept. at 216-292-6007 or e-mail us at firstname.lastname@example.org
Thank you for taking the time to update your information!
Providers, please click on the links below to access the the document or form you need: