Intake Appointment Form

INTAKE APPOINTMENT REQUEST FORM
Name

First NameLast Name
Student ID#
5 digit number
Student Status

Other
Graduate students must have at least one class fully in person
Email Address
Wheaton student email
Phone Number
Format: (000) 000-0000.
Permission to be contacted
Please indicate your availability below. For the quickest appointments, please select all options that apply, so that we are able to schedule your intake appointment as soon as possible.
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
We will schedule your intake appointment on the first possible date with any counselor, based on your student status and availability.
Comments:
Should be Empty:

INTAKE APPOINTMENT REQUEST FORM