Client Forms
You have taken the brave step to help yourself or a loved one. Help is available and treatment works.
We are here to get you started, set up for success, and support you along the way. Our comprehensive continuum of care, unmatched by most other programs, is designed to serve your needs, comfort level, and lifestyle.
Treatment Road Map
- If you need to get started, call us at (888) 928-5278 or (815) 391-1000. During this time, our access team will gather general information about the nature of your concerns and walk you through the next steps of providing screening and available treatment options.
- Rosecrance offers screenings and assessments at many convenient locations. These can also be conducted virtually. A caring counselor will help determine the right level of care and provide a referral for appropriate services.
- Complete these enrollment forms if requested by a Rosecrance employee. You can email these forms to forms@rosecrance.org or bring them with you to treatment.
- Healthcare Agreement: This form explains the relationship between you and Rosecrance regarding your healthcare and payment responsibilities, including expectations for our relationship, our obligations, and your obligations.
- Authorization to Release Information: This form disclosure allows the sharing of your treatment information to coordinate care.
- Client Rights and Responsibilities: This information applies to all Rosecrance programs and services, employees, and clients.
- In addition to our treatment options, Rosecrance also offers support services, including recovery homes, alumni services, family programs and counseling, intervention services, and parent support groups.
Client Forms
Healthcare Agreement
This form explains the relationship between you and Rosecrance regarding your healthcare and payment responsibilities, including expectations for our relationship, our obligations, and your obligations.
Authorization to Release Information
This form disclosure allows the sharing of your treatment information to coordinate care.
Client Rights and Responsibilities
This information applies to all Rosecrance programs and services, employees, and clients.
Outpatient programs
Rosecrance offers behavioral health outpatient services for children, teens, young adults, adults, and families both in person and virtually. Levels of care include individual, group, couples, and family therapy; intensive outpatient programs (IOPs); psychiatric services and medication management; TMS therapy; and medication-assisted treatment.
Residential services
Our residential services treat teens and adults experiencing behavioral health conditions, specializing in substance use and co-occurring mental health disorders. High-quality treatment is holistic and tailored to meet the needs and strengths of each individual. Length of program: 30–60 days.