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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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PSS-3

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.

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Financial Forms

Regardless of where you are in your journey, Crossroads offers services to help you reach the next step.  Click 'Getting Started' to see everything you need to know before getting treatment.

Financial Assistance Application

Crossroads knows there are times when our clients are unable to pay for the services provided.  If you need help paying for behavioral health services, you may be eligible for financial assistance from CBHS.

Financial Assistance

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