Wellness Appointment Scheduling

This form is monitored during business hours. Complete this form and someone will contact you to schedule by the next business day. This form is not meant for emergencies. If you need immediate assistance please dial 911, 988, or visit our 24-hr resource page at Crisis/24-7 Resources.

Student Name*

First NameLast Name

Mid Michigan College Student ID Number*

You can find your Student ID Number on your Mid Michigan College Student ID Card or in myMid.

Mid Mich Email*

example@midmich.edu

Phone Number*

Area CodePhone Number

Select the type of appointment you would like to schedule.*

Individual Counseling AppointmentLet's Talk AppointmentI'm Not SureOther

Select the location where you would prefer to meet.*

Mt. Pleasant CampusHarrison CampusOnlineOther

Student Signature*

Date*

MonthDayYear

Significant effort has been made to ensure this content meets accessibility guidelines. If you encounter a barrier you can report the barrier at midmich.edu/reportaccessibilitybarrier or contact Wellness at (989) 386-6622 x265 or wellness@midmich.edu..

In its commitment to providing a safe environment, Mid Michigan College actively endeavors to broaden our diversity, promote equal opportunity, and prohibit any form of discrimination in its programs, activities, and conditions of admission or employment. Learn more about these efforts and policies by visiting midmich.edu/eeo, midmich.edu/titleix, midmich.edu/securityreport.

Schedule Your Appointment Today!