Appointment Request Form

Important Note: If you are experiencing a mental health crisis or a medical emergency, do not use this form. Instead, call 911, go to the nearest emergency room, or reach out to a 24/7 crisis support service: Call or text 988 to connect with the Suicide & Crisis Lifeline or Text HOME to 741741 to reach the Crisis Text Line and speak with a trained crisis counselor. This form is intended for non-urgent counseling inquiries only and is not monitored for emergencies.