USA and Canada: 1-888-452-0091 | United Kingdom: 0-800-783-9631 | All Other Countries: 1-268-562-0035

Alumni Forms

The following are regularly requested forms that may be of use to alumni following their treatment experience.

Alumni Authorization:

The alumni authorization form provides permission for our continued contact with you for the purpose of supporting your ongoing recovery and providing you with additional information regarding our services. You may indicate your level of interest to become or request an alumni buddy in your region; to participate in alumni events, and to receive communications from Crossroads Centre.

– Please ensure returned forms are signed and dated.
– Please email or fax forms to alumni coordinator.

Release of Information:

If you are requesting medical records, presence in treatment letters, or information for insurance or tax purposes, please complete the consent form for disclosure of confidential information.

– Please ensure returned forms are signed, witnessed and dated.
– Please email or fax forms to the Clinical department secretary.

Aftercare and Recovery Program (C.A.R.E.) follow-up:

The Crossroads Aftercare and Recovery Program (C.A.R.E.) follow-up forms are available and can be completed and returned to the Alumni Services Department.

Change of Address

Please send us an email notification of any change of address so we can continue to send you alumni information.

Ray Huggins
Clinical Department Secretary
Tel: 268-562-0035 ext 5015
Fax: 268-562-0036