Appointment Form
Name *
Your answer
Phone Number *
Your answer
E-Mail Address
Your answer
Related to NOBTS? *
Select "Yes" if you are a student, faculty member, staff member, or a family member of any of those.
If yes and married, spouses name
Your answer
Preferred Appointment Time (Open Monday 8am - 8pm, Tuesday 7am - 8pm and Wednesday & Thursday 7am - 5pm) *
Please enter times that would be good for you to meet during the open hours listed above (e.g. Mondays or Tuesdays from 3:00 to 5:00). Note that this is not a guaranteed appointment time, and does not guarantee a session. A counselor will contact you regarding making your initial appointment.
Your answer
Brief Description of Issue
Your answer
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