Project Rise: Appointment Request Form

Full Name

Email (University of Virginia Email Addresses Only)

Preferred Phone Number

Peer Counselor Office Hours:
Tuesdays: 11 am to 2 pm
Wednesdays: 10 am to 1 pm
Thursdays: 10 am - 12 pm & 1 to 3 pm

List your available times on the date you requested:

Select concerns you are having:

Academic problems

Anxiety & Panic

Depression

Discrimination & harassment

Identity problems (gender, religious, or sexual)

Relationship concerns

Roommate problems

Substance use concerns

Other

Briefly Describe

We will respond shortly confirming an appointment time for you. However, if this is an emergency, please do not wait for a response. Instead, call 243-5150 to speak with an on-call clinician or call 911 for emergency services.