Client Forms

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BASIC INFO

Let's start with the basics.

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BHIS REFERRAL 

FORM

Providers outside of Crossroads can refer clients to BHIS.

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IHH/PEER SUPPORT FORM

Interested in Integrated Health Home and/or Peer Support services? 

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PHQ-9 PRE

How have you been feeling?

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CHANGE PROVIDER

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

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ONLINE 

BILL PAY

Would you like to pay your bill online?

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GAMBLING/SBIRT

Drug, alcohol and gambling questionnaire.

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TELEHEALTH CONSENT FORM

Interested in telehealth services? 

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JAIL DIVERSION

REFERRAL FORM

Our Jail Diversion program assists inmates with mental health issues, both in jail and in the community.

Satisfaction Surveys

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NEW CLIENT

Share your opinion about our client on-boarding process.

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MID-TREATMENT

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

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DISCHARGE

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

What to Expect

Client Experience

Getting Started

Upon arriving at our facility, you will be be greeted by our friendly registration staff. They will assist you as you complete the intake process and will help schedule you with a counselor or therapist based on your needs. Our lobby is quiet, clean, and calming and is complete with a complimentary snack bar. Rest assured, our staff is here to help make you feel comfortable and you can expect the strictest confidentiality of all information shared with us.

Beyond the Intake

Take part in your care

Crossroads Behavioral Health Services, we are dedicated to offering a whole-human approach to mental health care and addiction abuse counseling. Once you have met with your therapist or counselor and have completed the intake process, you will be directly involved in developing the care plan which is right for you. You will receive the highest quality of care and evidence-based treatment that fits your individual needs.

Your Rights

#CrossroadsCares

  • The right to privacy.

  • The right to report any dissatisfaction and grievances.

  • Freedom from any form of abuse, retaliation or humiliation.

  • Access to pertinent information in sufficient time to help your decision making.

  • Informed consent or refusal.

  • ​Timely access to information​.

  • Access and/or referral to additional services.

  • Investigation and resolution of alleged infringement of rights.

  • Equal opportunity.

What To Bring

#CrossroadsCares

  • When you arrive at Crossroads, we ask that you bring with you:

    • Photo ID

    • Insurance Information

    • Proof of Income

Cost of Services

#CrossroadsCares

  • Crossroads accepts personal checks, money orders, cashier checks, credit cards and cash payments.

  • Crossroads is a provider for many insurance companies. Be sure to bring your insurance information with you to each visit. 

  • For those who qualify, financial assistance for services is available.  A financial assessment of resources and/or insurance is completed during your first visit. 

Your Responsibilities

#CrossroadsCares

  • Read (or be read), understand, and comply with the program rules and expectations.

  • Provide full information regarding any treatment, including all types of counseling/therapy, medications, and/or hospitalizations.

  • Actively participate in the treatment planning and counseling process.

  • Attend all activities as agreed upon with staff and indicated on the treatment plan.

  • Keep scheduled appointments or cancel at least 24 hours in advance.

  • Pay assessed fees, as agreed, in a timely manner.

  • Maintain the confidentiality of the program and of other patients at all times.

  • Inform staff of any medications being taken.

  • Refrain from possessing or using weapons and doing illegal activities.

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