Provider Interest Form

To receive an application to apply for network participation, please complete the following form. We only accept fully licensed, independent providers. Please note that if we are not recruiting in your area, you will not receive an application packet. We will keep your information on file and will reach out in the future when your services are needed. Please do not resubmit an interest form if you do not hear from us.

If we are recruiting in your area, you should receive an application packet within two to three weeks of ComPsych’s receipt of your interest form.

* Required

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