CAPS Services Request Form
Please note that these form submissions are NOT monitored 24/7. If you need immediate mental health support, please call (805) 893-4411 and press 2 to speak with a live counselor. If this is a situation that involves potential harm to self or others, please call 911 immediately.

Submissions will be reviewed during CAPS business hours -
PERM# (if you are a UCSB student)
Phone Number *
May we leave a voicemail if you are unable to pick up the phone? *
Email Address *
What is your preferred form of communication for our follow up? *
How can we help you? *
If you selected Group Counseling Pre-Screen, which group(s) have you submitted an interest form for? (if not interested in Groups, please skip this question) *
By checking this box, you acknowledge that you understand that this request form is NOT monitored 24/7 and that you will seek out emergency services if you are in a situation that could involve harm to self or others. *
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