Counseling Forms

New Client

If you are an ACU student, staff, faculty or dependent and interested in receiving our counseling services and want to make an appointment, you can come by our office and fill out the Intake form, or you can complete the "Counseling Intake" Form on-line.

You must be on campus to access this online form.
Click "Counseling Intake" and follow the instructions.
At the bottom of each page there is a 'Cancel', 'Continue' or 'Submit' button. Please double check you click the correct button. If you cancel at anytime, you will be redirected to the beginning of the form.

There is also a page requesting information concerning current & past symptoms. Once you click a 1-3, you cannot clear your response. So, skip the symptom if it does not apply to you.

Your StudentID is your ACU BannerID. 
Once completed, this form will be submitted for processing.

An appointment will be made with a therapist within 48 to 72 hours upon receiving your intake form. If this is an emergency please call our office directly at 325-674-2626 Monday-Friday, 8am-5pm or after hours call 911 or the ACUPD at 325-674-2911.