top of page

About Us
Employees
Employers
Providers
- Forms
Contact
More

Use tab to navigate through the menu items.

SUBMIT AN INVOICE

Please complete all required fields and submit

This form must be submitted within thirty (30) days of each date of service.

Make check payable to

Email

Company name?

Billing Address?

Business Address?

Counselor Name

Client Name

Client Date of Birth

Employee Name

1st Appointment Date

1st Appointment Session Cost

2nd Appointment Date

2nd Appointment Session Cost

3rd Appointment Date

3rd Appointment Session Cost

4th Appointment Date

4th Appointment Session Cost

5th Appointment Date

5th Appointment Session Cost

Total Cost For All Sessions

Counselor's Signature

By entering your name above, you are digitally signing this invoice.

INVOICES MUST BE SUBMITTED WITHIN 30 DAYS OF EACH DATE OF SERVICE TO BE ELIGIBLE FOR REIMBURSEMENT.

Thank you for submitting. We have received your invoice.

Employee Assistance Associates and Consultants of Oklahoma

6585 S. Yale Ave Suite 340

Tulsa Oklahoma 74136

918-481-2999 or 1-800-477-2990

Fax: 918-393-4055

Copyright© 2045 EAACO. All rights reserved.

bottom of page