Counseling Interest Form
In collaboration with Houston Hillel, Jewish Family Service Houston offers mental wellness support for undergraduates, graduate students and young professionals served by Houston Hillel, Jewston, and QJews.

Please complete this form to the best of your ability and Kedem Blatt, Houston Hillel's Jewish Family Service Counselor, will respond to your inquiry, typically within two business days.

The responses to this form are accessible only to Kedem and Jewish Family Service staff who support Kedem's work with Houston Hillel's participants. Your outreach will remain confidential, including to Houston Hillel staff.

Please Note: This form should not be used in a crisis situation.

If you are experiencing a behavioral health-related emergency please access the National Suicide Prevention Lifeline at 800-273-TALK, (8255) or by calling 911 or accessing your closest hospital emergency room.
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First *
Last Name *
Contact Number *
E-mail Address *
Preferred Contact Method *
Please check availability
Affiliation *
If a student, please indicate your campus.
Is there anything you’d like Kedem to know before she reaches out to you? If you are comfortable, please briefly share your counseling and/or support need.
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