Please complete this form if you would like to speak with someone about receiving counseling from our Well-Being Services program or would like a referral to a LGBTQ+ affirming mental health provider. If you need to speak with someone immediately, please go to our Hotlines page to see a list of available hotlines.

Once completed, this form will be routed to the Director of Well-Being or a member of the WBS team. You will receive a response within 48 hours (two days).