Become a Member / Make a Referral

Becoming a Crossroads Member

A prospective member wishing to do a Self-Referral can download a Self-Referral Form by clicking here: Self-Referral Form

Someone else referring a prospective member can download a Referral Form by clicking here: Referral Form

Please send the completed form to both the Program Director Earlene DeYoung (edeyoung@riversidecc.org) and Intake Coordinator Barbara Smith (bsmith@riversidecc.org).

Referral forms can be accepted by email, mail, or fax (508-634-2602).

Once received, the Intake Coordinator will reach out to schedule tours, and then orientation.

Tours and Orientations are scheduled are scheduled Monday – Friday between 10:00am - 3:00pm

If a prospective member self refers, Crossroads will ask the person to identify someone who knows them well (a therapist, prescriber, ACCS or PACT clinician, primary care physician, nurse practitioner, etc.) who the Clubhouse can contact to get further information to help establish DMH Clubhouse Eligibility. They will need to sign a release form so the Clubhouse can contact the person. The release form can be found here: Release Form.

If the prospective member does not currently have anyone in any of the roles identified above, the Clubhouse will work with the individual and the DMH Site office to establish DMH Clubhouse eligibility.

Please feel free to call 508-473-4715 for more information.