Initial Request to Connect - Counseling Center

If you feel that you need immediate assistance, please contact Colorado Crisis Services at 1-844-493-8255 or text TALK to 38255. For life threatening emergencies, please dial 911.

*Required Field

Name*

First Last

Preferred Name/Pronouns

Mines Email Address Required (others go to junk mail)*

Enter Email Confirm Email

CWID*

Phone #*

Current City*

Golden

Current State*

Colorado

Please choose from the service request options below*

Schedule an appointment with a counselor for a 15 minute phone consultation to determine next steps.

Drop in Monday, Wednesday & Thursday from 11:30am-12:30pm or Tuesday & Friday from 2:00-3:00pm for a personalized consultation with a counselor from the Counseling Center.

Join here via zoom: https://zoom.us/j/92996807583

Please review Virtual Office Hours Consent prior to attending.

Reason for Request*

Please list a brief reason for your request so that we can connect you with the appropriate counselor or resource.

Availability*

Please list times that you are available M-F 8:00am-5:00pm to receive a 15 minute phone consult from a Mines counselor. We will schedule you in the next available appointment that matches your request and respond by email with your appointment date and time.

Receive personalized referral assistance to counselors in the community.

Health Insurance Coverage*

Sessions*

In Person
Virtual

Additional Information:*

Please provide any specifics important to you in your search for a therapist (i.e. specialties, language, gender, etc.)

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