Welcome to Crossroad Counseling and Consulting Associates, PC, your Psychiatry and Mental Health provider!

Our new patient registration forms and consent forms are available for download on this page or in our office when you arrive for your first appointment. We kindly ask you to complete these forms before your visit. Please bring the completed forms, your insurance card, government issued identification, and your payment to your first visit. If you chose to complete form in the office before you first appointment please arrive 20 minutes prior to your appointment time.
New patient packet is your way to introduce yourself to our practice and it provide valuable information to our administrative and clinical staff. Each of the questions will help our physicians and clinicians in assessment of your problems. If you would like to receive a copy of the forms please notify the receptionist.

Software you’ll need

To view and print our office forms you’ll need the freely available Adobe Reader software installed on your computer. It is recommended to upgrade to current version of Adobe Reader.

Adobe Reader XI can be downloaded is here: http://get.adobe.com/reader

Your web browser may be configured with an Adobe Reader plug-in to automatically open the file within your browser’s window when accessed. We recommends that you save the PDF file to your computer and access the file locally. This allows the full Adobe Reader application to interface with the form. To download the file directly to your local drive, use right click of the mouse on the button then select “Save Target/Save Link As…” from the menu. Use Adobe Reader to open the file.

Printing the forms

Open the form using Adobe Acrobat Reader or Adobe Acrobat. Go to “Print” either in the “file” menu or by selecting the print icon. Once the print dialogue box is open, select the “fit to page” option. This ensures that the page that you see on the screen will correspond to the page printed by your printer. Once forms are printed please complete with dark pen, date, sing and bring to the office at the time of your visit.

Downloading the forms

You can download all forms below (number 1 thru 10).

  1. New Patient Registration Form
  2. New Patient Confidential Intake Form
  3. Notice Of Privacy Practices
  4. Acknowledgement of Receipt of PP notice
  5. Statement of Client Rights & Responsibilities
  6. Therapy Treatment Agreement Children and Adults
  7. Prescription Medication Information
  8. Email Correspondence Consent
  9. Service Agreement & Consent to Treatment