CSEAP Pop Up Clinic Appointment Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please request an appointment for one of our Pop Up Clinics for individual, couples or family counseling by completing this web form. CSEAP may require up to 2 business days to respond to this form submission. If you are experiencing an urgent mental health or other crisis, please call CSEAP at 303-866-4314 for more immediate response. For counseling requests, state employees have confidential access to 8 counseling sessions per rolling year; note that CSEAP is not a long-term therapy provider and uses a brief solution-focused model.

Sessions are by APPOINTMENT only. Pop Up Clinics are held at the following locations:

Pueblo: IDS, 2 Jetway Ct., Pueblo, Colorado 81001

Steamboat Springs: Routt County Justice Center, 1955 Shield Drive, Steamboat Springs, CO 80487; ADR room (127)

Buena Vista: Pinion Room at the Community Center

715 E. Main Streeet, Buena Vista, CO 81211

Sterling: Northeastern Junior College, 100 College Ave, Walker Hall, Room 210, Sterling, CO 80751

Durango: Location TBD

Email *

Record my email address with my response

First and Last Name: *

Are you employed by the State of Colorado (you are a 'state employee' and receive your paycheck from the state)? *

By statute, CSEAP is only available to serve those employed by the State of Colorado.

Yes

Please provide your state issued email address. This email address will only be used if you select it as your preferred email *

Clear form

Never submit passwords through Google Forms.

This form was created inside of State.co.us Executive Branch. Report Abuse

Forms