Welcome to Betterlife Directions's Provider Registration Centre.

To apply for registration as a provider of Psychological services for Betterlife Directions's Employee Assistance Program (EAP) please complete the form below. (Allow 20-30 minutes to complete)

A representative from Betterlife Directions will contact you within 3 business days to discuss your application.

Fields marked with a * are mandatory. Your registration will not be sent if you do not complete all these fields.

APPLICATION FOR REGISTRATION AS AN Betterlife Directions EAP PROVIDER
Personal Details
Full Name*:	Dr Mr Mrs Ms
	Title*	First Name*	Initial	Surname*
Location*:	ACT - Canberra ACT - Other NSW - Sydney NSW - Regional QLD - Brisbane QLD - Regional SA - Adelaide SA - Regional VIC - Melbourne VIC - Regional WA - Perth WA - Regional TAS - Hobart TAS - Regional NT - Darwin NT - Regional NZ - New Zealand (multiple selection possible by holding down SHIFT key and clicking selection)
Personal Contact Details
Home Address:				QLD NSW VIC SA ACT WA TAS NT New Zealand
	No*.	Street name*	City*	State*
	Australia New Zealand
	Country		Post Code*
Phone:
	Daytime Phone*		Mobile Phone
Internet:
	Email address*

 

 

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