Make an Appointment

We look forward to talking to you about Crossroads. This contact form will help you access treatment or ask questions about obtaining services at Crossroads. If you are in crisis and in need of immediate assistance, please call 911, visit your local Emergency Room or call 207-774-HELP

Please note: Electronic mail is not a completely secure and confidential means of communication. Non-encrypted electronic communications may be accessed and viewed by other Internet users without your knowledge and permission while in transit to us. Therefore, we recommend that you contact us by phone whenever you are communicating personal information to us.

Please complete the form below (only fields marked with * are required). A Crossroads staff member will respond to you within 1 business day.

First name *
Last name *
Phone number *
Email address *
Can we leave a message for you?
YesNo
Are you a referral agent? *
YesNo
Are you a concerned friend or family member?
YesNo
What program are you inquiring about? *
Greater Portland Counseling CenterKennebunk Counseling CenterBack Cove Residential ProgramCo-Occurring Eating Disorders Residential ProgramChildren and Mothers Program (CAMP)
Client Insurance Type: *
Client Date of Birth: *
Insurance Provider & Phone #:
Insurance ID #: *
Social Security # (optional):
If you are looking to book an appointment, please tell us what days and times are best for you:
Days: MondayTuesdayWednesdayThursdayFriday
Times: MorningAfternoonEvening
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