Financial Support

Crossroads accepts most insurances and self-payment. We will work with you and your insurance provider to ensure that your benefits are explored to the fullest and we will advocate for you to make sure your benefits are working for you and your treatment plan.

Through the compassionate generosity of donors in the community and former clients and their families, a limited amount of financial assistance may be available to those who meet the financial needs assessment criteria. To learn more about financial assistance, talk with our admissions staff. Full scholarships are not offered.

 

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Verify Your Insurance

 

 

 


CLIENT INFORMATION:


 


 

 

 

 

 

 


INSURANCE INFORMATION:


 

 

 

 

 

 

 

 


CLIENT HISTORY:


 


Previous Treatment


 

 

 


 

 

 


Previous Incarceration, Detention, or Probation:


 

 

 

 

 


CASE MANAGER OR INTERVENTIONIST:


 

 

 

 

 

 

 

 


CURRENT PHYSICIAN:


 

 

 

 

 

 

 

 

 


ROUTINE MEDICATIONS - Please list each medication taken, the reason, Rx # on bottle, dosage, and prescribing physician:


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