I am a mental health professional and want to access the Matrix Network

General

• EAP Assessment Form
• EAP Closure Summary Form
• EAP Policies and Procedures
• Authorization to Obtain/Release Protected Information

Reimbursement

• EAP Provider Reimbursement Form

Recredentialing

• EAP Recredentialing Form

We thank you for your continued willingness to participate in the Matrix EAP Provider Network. In order to maintain the very high standards we have promised our corporate Employee Assistance Program clients, as well as to avoid ever giving a patient incorrect contact information for your office, we annually ask that you legibly complete the Matrix Provider Recredentialing Form every year. Kindly print off the form from this website and send it together with a copy of your current license and malpractice insurance verification to:

Contact Address

Provider Relations
Matrix Psychological Services
2 Easton Oval, Suite 4500
Columbus, OH 43219
Fax: 614-475-9821