Campus Community
Health And Counseling Services
Submit a Counseling Appointment Request

Submit a Counseling Appointment Request

Please don't fill out this input box.

Name*

Pronouns

Are you 18 years of age or older?*

Yes

Current address*On-campus hall and room number if applicable

Washington College e-mail address*

What type of services are you requesting?*For example: on-campus counseling, off-campus referral, medication management, specialized care, etc.

If you are requesting assistance finding an off-campus provider please provide the following information: Preferences such as identity factors, health insurance provider, in-person/virtual, other barriers to mental health services.

Are you currently seeing a therapist?*

Yes

Please list the day(s) and time(s) you are available for an appointment?*

I am not currently experiencing an active mental health crisis and can wait for a call back within current/next business day.*

Endorsement

If the emergency is life-threatening, call 911, call public safety, or go to the nearest emergency room.

Additional resources:
Eastern Shore Mobile Crisis: 888-407-8018-988 (text or call)
For All Seasons 24-hour confidential hotline: 800-310-7273