SHAC

Counseling Services: Ask a Question / Consultation Request Form

This Consultation Request Form is used to ask a question about a mental health issue (such changes you have observed in yourself or others) or about the practice of psychology (such as what to expect if you come to counseling or the types of counseling available).

This form is NOT to be used to report an emergency. If this is a medical or psychological emergency involving immediate threat of harm or violence, substantial disruption, or a situation requiring immediate action, please contact UNM Campus Police at 9-1-1 or (505) 277-2241.

* = Required

Name *

 

E-Mail *

Confirm E-Mail *

* This helps to ensure that we have your correct e-mail address, and that you will receive a reply as quickly as possible.

Phone *

 

Preferred method of contact? *

I am a:

Please select one option from drop-down menu. *

 

If you indicated "Other" above, please describe:

Is this for a class assignment? *

If yes, what is the assignment deadline? Example: mm/dd/yy

What is your question or the nature of your concern? *

* Disclaimer: Please be aware that e-mail is not a secure medium and refrain from submitting identifying information such as names, identification numbers, and other identifying personal or health information.

Sources already consulted:

* Note: Knowing where you've already looked will help us keep from sending you some place you've already been.