Crossroads Interest Form
Thank you for your interest in Crossroads Recovery Group. Please fill out whatever information you feel comfortable below and we'll contact you in regards to where/when the group meets.
What's your first name?
*
What addiction are you currently seeking/in recovery from?
*
What's the best way to contact you?
*
Email
Phone (Call)
What is the email address and/or phone number? (This will only be used by the Crossroads Facilitator)
*
Submit
Should be Empty: