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.


facebook

Mark your calendars for our 2nd annual art show! They'll be some of our clients' beautiful art, cocktails and appetizers, and a prize raffle! you can get more information in the link bellow!

www.shoreupdate.com/cci/
... See MoreSee Less

View on Facebook

We've been featured on Queen Anne's County Television - QACTV!

www.youtube.com/watch?v=mh0XGJ8OWo0

Make sure to come to our client art show and check out this beautiful bench we're auctioning off!

www.shoreupdate.com/cci/
... See MoreSee Less

View on Facebook

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

John Alan and Mary Watson
Almon "Barry" Barell
Gerald and Vicky Sawyer

You can get more info on helping out here: www.ccinconline.com/donate/
... See MoreSee Less

View on Facebook

We're auctioning off this beautiful bench by local artist Lea Brooks in support of crossroads! Click here to learn more:http://www.shoreupdate.com/cci/ ... See MoreSee Less

View on Facebook

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

Michael Grogan
Gary and Nancy Robson

You can get more info on helping out here: www.ccinconline.com/donate/
... See MoreSee Less

View on Facebook