CEW+ Counseling Appointment
Request Form

CEW+ Counseling Appointment Request

Please fill out this confidential form to request an appointment with a CEW+ Counselor. Within 2 business days after your form is submitted, a member of our team will be in touch (via phone or email) to formally schedule your appointment.

You can also call 734-764-6360 to schedule an appointment.

First Name

Last Name

Preferred Name

If not first name.

Phone Number

Pronouns

How would you prefer to be contacted?

We do the majority of our scheduling via email. If you would prefer to schedule via phone, select phone.

However, please be advised that scheduling confirmation and reminders, and additional information will be sent via email.

Phone

Have you had an appointment with CEW+ before?

Which of the following best describes you:

U-M Student

U-M Staff

U-M Faculty

Community Member

In which format would you like your appointment to be?

Briefly describe reason for appointment:

Additional Comments:

Send me a copy of my responses

Report Abuse

CEW+ Counseling Appointment Request Form

CEW+ Counseling Appointment Request

CEW+ Counseling Appointment
Request Form