TERM Applications
Instructions
|
Form W-9 (Rev. December 2014)
|
Request for Taxpayer Identification Number and Certification | 2017-11-02 |
|
Instructions_and_FAQs_Credentialing_and_Contracting (pdf)
|
2022-04-05 |
Credentialing Application
|
1.1 Credentialing Criteria (pdf)
|
2020-01-30 | |
|
Credentialing Application Instructions (pdf)
|
2020-02-26 |
TERM Therapist Applications
| TERM Therapist Clinical Application (docx) | Revised 01/12/2026 | 2026-01-12 |
| Writing Sample Packet for Therapists (pdf) | 2025-09-18 |
TERM Evaluator Applications
| TERM Evaluator Application (docx) | Revised 01/12/2026 | 2025-04-15 |
| Writing Sample Packet for Evaluators (pdf) | 2026-01-12 |
Interns
| Optum TERM Intern Application (pdf) | 2025-11-06 |
Specialty Addition Applications
| TERM Evaluator Specialty Addition Application (docx) | Revised 04/11/2025 | 2023-04-15 |
| TERM Therapist Specialty Addition Application (docx) | Revised 05/01/2025 | 2025-05-06 |