Register for Services

Registration is simple.  If you are a prospective client begin your registration over the phone (parent or guardian may register a minor).  See our LOCATIONS page for hours of operation, phone and fax numbers.  Or, you may download a registration packet from the link below.  Or, call and request a registration packet to be mailed to your home address.

Submit registrations completed remotely to the desired clinic location via email scan, USPS mail or fax.  After the registration is processed, you will be given an appointment for a clinical intake.

Bring with you or send copies of the following items:

  • All current Insurance Cards – primary and secondary
  • Photo ID
  • Patient Social Security Card
  • Primary Medical Doctor’s name, address and phone number

If Patient is a minor, you will also need to bring in or send copies of:

  • Proof of custody ( Custody order)
  • Proof of address
  • Immunization record
  • Birth certificate

If you currently have no insurance, please bring in or send copies of the following for income verification:

  • 3 most current pay stubs  OR
  • Prior year tax return

Choose the packet that applies to your situation:

Print and fill out either the Adult or Child Information Packet, whichever applies to your situation. If you cannot print out the Information Packet, you can fill it out when you arrive for registration. But it is a great time saver if you can do it in advance.

Download/print Adult Information Packet

Download/print Child Information Packet

Notes:

Children are not required to attend the registration meeting.

Acceptance and schedule for intake is dependent on qualifying for services, and if required, obtaining authorizations for services.

Failure to provide all necessary documents can result in no scheduled clinical visits.

Please be advised that there is a Wait List for ALL private insurance. In order to be added to the list, the registration process must be completed.


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This "Thank You Thursday" we're giving a shoutout to some of the people who help make what we do possible:

Pere and Phyllis Roberts
Wayne Zussman
George and Barbara Yewell

You can get more info on helping out here: www.ccinconline.com/donate/
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Please join us for our next Friendraiser and learn more about Crossroads! Meet staff and board members and enjoy lite fare. The event is scheduled for Saturday May 4th, 5-7pm at St. Paul's Parish in Centreville. ... See MoreSee Less

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We're gonna be at The Shore Update's Shore Kids Connection on May 11th! Make sure to come out and say hi! ... See MoreSee Less

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Local artist Lea Brooks gifted this exquisite, mosaicked bench with a butterfly to be raffled in conjunction with Crossroads Community’s Annual Client Art Show. For Crossroad’s clients, the butterfly has come to represent freedom as “Butterflies Are Free:” Freedom from the struggle that individuals with mental illness experience everyday due to stigma, prejudice, and bias. Whether you’re interested in supporting mental health in our community, or you're interested in this beautiful mosaic chair, you can purchase raffle tickets here: go.rallyup.com/cci ... See MoreSee Less

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