Becoming A New Patient

Download, complete, and return the 'New Patient Acceptance Request' PDF form below. 

Patient Acceptance Request Rev 20180725.[...]
Adobe Acrobat document [100.2 KB]

Check with your insurance company to ensure that at least one of the providers at Crossroads is in-network for your specific insurance plan.  Also keep in mind that Crossroads does not offer chronic opiate (narcotic) or benzodiazepine management.


This form can be submitted by being dropped off at our office, mailed, faxed, or emailed to the clinic at your convenience.  Feel free to call the clinic for more information or if you have problems downloading this form.


Crossroads is not currently accepting new patients whose primary coverage is Medicaid (or a Medicaid managed care plan).  This includes anyone applying for or with a pending Medicaid application.


Once accepted as a patient at Crossroads, you will need to download, complete, and return all the forms included in the 'Annual Patient Packet' below.

Patient Packet Rev 20170601.pdf
Adobe Acrobat document [130.4 KB]
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