Counseling Center Registration Form
****Please be advised that we are not taking any further registrations for the current term. You are more than welcome to complete a registration, however it will not be processed until the beginning of the Fall 2019 term, on or after 9/4/19.***

Please note that we are not able to provide substance abuse counseling, nor are we able to provide court mandated counseling services. If you are experiencing suicidal thoughts, feelings or urges please contact Common Ground (800)231-1127, the National Suicide Prevention line (800)273-8255 or go to the nearest emergency room.

Did you read the disclaimer above and are you agreeable to waiting until after 9/4/19 to be contacted?
Full name (first and last) *
Your answer
Address (include city, state, and zip code) *
Your answer
Preferred phone number where a message may be left *
Your answer
Are you an OU student? *
Are you willing to participate in research? *
Emergency contact (name and phone number) *
Your answer
Availability
For the following questions, please provide ALL times that you are available on each day.
Monday (9 a.m. - 9 p.m.) *
Your answer
Tuesday (9 a.m. - 9 p.m.) *
Your answer
Wednesday (9 a.m. - 9 p.m.) *
Your answer
Thursday (9 a.m. - 9 p.m.) *
Your answer
Friday (9 a.m. - 3 p.m.) *
Your answer
Saturday (9 a.m. - 3 p.m.) *
Your answer
Who referred you to the SEHS Counseling Center? *
Your answer
Submit
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