Refer to Us

Online Referral Form


If your client has consented to a referral, you may call us at 207.773.9931 or use this form. While your email transmission will be encrypted in an effort to protect the confidentiality and security of the information provided, we recommend that you contact us by phone whenever you are communicating more detailed personal information.

Please check one and submit the form — your information will be sent to that facility •
All fields are required!
Great Portland
Counseling Center
71 US Route One, Suite E
Scarborough, ME 04074
P: 207-773-9931
F: 207-879-5576
 Residential Intake
& Admissions
132 Main Street
Windham, ME 04062
P: 207-894-5733
F: 207-894-5735
 Kennebunk
Counseling Center
2 Livewell Drive, Suite 202
Kennebunk, ME 04043
P: 207-467-3369
F: 207-467-3413
Referred by •
Referral phone # •
Client name •
Client date-of-birth • / /
Client phone # •
Client insurance type •
Insurance ID # •
Reason for visit •
 
Crossroads provides gender-responsive addiction and behavioral treatment services in a safe and respectful environment so individuals and families can lead healthy lives.