The Counseling Team International

Phone: 1-800-222-9691 | Stand By Status (SBS) Available 24/7/365 32x32-Square-54-FB

DEA Employee Assistance Program Forms

#1 Admission

#2 Statement of Understanding Blank

#3 Service Receipt

#3b Area Clinician Multi-Use Service Receipt (3-28)

#4 Client Satisfaction Survey

#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

#13 Consultation Request Form

#14 Consultation Service Receipt

#15 Request for Training

Client’s Consent to use Skype for EAP Counseling

Confidentiality Guidelines (EAP)