Client Forms

BASIC INFO

Let's start with the basics.

SBIRT - PRE

Drug & Alcohol consumption assessment

TELEHEALTH CONSENT FORM

Interested in telehealth services? Fill out this informed consent form for telehealth services.

PHQ-9 PRE

How have you been feeling?

BHIS Referral

Providers outside of Crossroads can refer clients to BHIS.

GAMBLING

Problem Gambling questionnaire

CHANGE PROVIDER

If you're looking to change your Crossroads provider, please submit this form.  

Satisfaction Surveys

NEW CLIENT

Share your opinion about our client on-boarding process.

MID-TREATMENT

Your opinions are valuable, and we want to hear them.

DISCHARGE

Treatment is complete - We'd love to hear from you!

Email: crossroads@crossroadsbhs.org

Phone: 641.782.8457

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