Centenary Counseling Services Appointment Request Form

Confidentiality is a priority.

Confidentiality practices will be discussed further at your initial appointment. Once your request is received, you will get an email or text message to schedule an appointment. You may also schedule an appointment by calling the office directly at 318-869-5466.

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* 1. First and Last name

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* 2. Centenary email address

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* 3. Phone number

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* 4. Preferred method of communication

Text message

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* 5. Have you been seen by Centenary's Counseling Services in the past?

Yes

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* 6. Please list your availability for an appointment (i.e., Monday mornings, Wednesday between 1pm-3pm, etc.) Counseling Services office hours are Monday-Thursday 8am-5pm and Friday by appointment only.

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* 7. In a few words, please describe what brings you to Counseling Services. (i.e., stress, anxiety, relationship problems, etc.)

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* 8. This system is not monitored 24/7. If you are in an emergency situation and the Counseling Services office is closed, please contact immediately:

-Centenary campus police: 318-869-5000 or 318-207-0007
-9-1-1
-National Suicide Prevention Lifeline: 1-800-273-8255
-Crisis Text Line: Text "Hello" to 741-741

I understand that, if I am in a crisis, I will contact one of the entities listed above.