For your convenience, the forms to the right are available to download as Adobe Acrobat PDFs.
If you are unable to view PDF files, download the free viewer from Adobe.
Print your application and mail it with your license, resume, and proof of professional liability insurance to:
Provider Relations Department
29 East Madison, Suite 1600
Chicago, Illinois 60602
Questions about the application process? Call us at (866) 377-5550 or email to firstname.lastname@example.org.
Once you have been accepted onto ERS’ Affiliate panel, you may begin to receive EAP case referrals. Complete the paperwork as directed below:
Employee Resource Systems 29 East Madison Suite 1600 Chicago, Illinois 60602
Phone: 312 780 6316 Toll Free: 800 292 2780 Fax: 312 780 6344