Phone: 1-800-222-9691 | Stand By Status (SBS) Available 24/7/365
DEA Employee Assistance Program Forms
Forms can be faxed to 760-636-0437, or emailed to: deaeapbilling@thecounselingteam.com
If you have any questions or need additional information, please call us at 800-651-1021.
#2 Statement of Understanding Blank
#3b Area Clinician Multi-Use Service Receipt (3-28)
#5 Consent for Release of Confidential Information
#7 Threat of Violence Action Form
#8 Clinician Self Referral Disclosure Form
#9 Traumatic Incident Report Form
#10 Formal Supervisory Referral Authorization to Release Confidential Information
#11 Authorization to Extend Sessions
#14 Consultation Service Receipt
Consent to use Teletherapy or Telephone Sessions