Sun prairie Location Paperwork
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Outpatient Intake Paperwork
Prior to your/your dependent’s first outpatient appointment, fill out these forms.
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Day Treatment Intake Paperwork
These forms must be filled out by parent/legal guardian and client prior to intake assessment for Adolescent Day Treatment.
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Day Treatment Referral Form
If you are a physician, psychiatrist, school staff, or outpatient therapist you can fill out this form to refer a client to our Adolescent Day Treatment program at either location.
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Day Treatment Survey
If your child has completed our Adolescent Day Treatment program, we want to hear your feedback on your experience!
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Under 18 Medication Form- Hasan Raza
Clients who receive medication management through Crossroads Counseling will fill out and sign this form upon request and permission from your provider.
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Over 18 Medication Form- Hasan Raza
Adult clients who receive medication management through Crossroads Counseling will fill out and sign this form upon request and permission from your provider.
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SPSD In-School Mental Health Therapy Referral Form
This form is for school staff from SPASD to fill out to refer a student for in-school mental health therapy services.
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Release of Information
Perspective clients and guardians, please fill this form out so that we can communicate with other providers and emergency contacts. Please fill out one form per contact.
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Contact Form
For any other questions, inquiries, or information, please contact us using this form.
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Annually Required Documents
These are documents that all current clients at all locations need to fill out and update ever year.
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Email/SMS Consent Form
Current clients can fill out this Email/SMS consent form to allow other forms of communication.