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Counseling Services Request Form

Counseling Services Request Form

This form will allow you to request an appointment with Counseling Services. You will receive an email from a MSOE Counseling Services staff member based on your response. 

If you are experiencing a mental health emergency, please call Public Safety if you are on-campus (414-277-7159) or 911 if you are off-campus.

* = required field

ATTENTION: OUT OF OFFICE

The Counseling Services team is currently out of office. Our office will resume regular hours, and we will attend to any correspondence we receive until then, on January 6, 2025. Happy New Year!

Full (Legal) Name *
Preferred Name *
Phone Number *
Student Status *
Have you been diagnosed with a mental health condition(s)? *
Do you have a history of suicidal thoughts and/or behaviors? *
If "yes" to the previous question, have you experienced suicidal behaviors and/or suicidal thoughts with intent to act in the last 24 hours? *
Symptoms/concerns you have (check all that apply) *
The type of support I think I am looking for at this time is... (This will be discussed further when you meet with a counselor.) *

Within 48 business hours of you submitting this form, a staff member will reach out to you via email to discuss next steps. Thanks!

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