Provider Form Download Area
Please click on the form you require. Print and fill out form. Send completed form to our secure clinical fax at
713-781-4954.
Adobe Acrobat is required to download the files on this page. You may download it for free by clicking on the Adobe Acrobat Reader icon.
|
Application- Individual Provider. (All therapist: Please download the PIP Questionnaire listed below) |
Click Here |
| Application-Facility |
|
>
|
Patients Rights and Responsibilities |
Click Here |
Explanation of Benefits - Release of Information |
Click Here |
|
MHC Responsibility and Procedures |
Click Here |
Clinical Feedback Form |
Click Here |
|
PIP Questionnaire |
Click Here |
Refer your Psychiatrist / Therapist |
Click Here |
Provider Manual Download Area
For more information or a customized quote please contact us at:
10370 Richmond Ave. | Suite 1100 | Houston, Texas 77042
Phone: (713) 781-3364 | Fax: (713) 784-0425
Toll Free 800-324-4327
Email:info@ieap.com |
