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CHC Mental Health Triage

Do not submit this form if you need emergency help! If you are in a mental health emergency and are on campus, call WSU Police at 313 577-2222. If you are off campus, please call 911 or go to the nearest hospital emergency department.

*Other great options during crises include calling 988 (National Suicide and Crisis Lifeline) or using the Crisis Text Line (741-741).*

This brief request form is for students seeking non-emergency mental health services. All students have several good options available to them – a Campus Health Center triage clinician will discuss your needs with you and point you in the direction of the options that are the best fit for you.

It may take several hours for our triage clinician to be able to see your request and contact you, so on weekdays after 2:30p you might be contacted the next business day. Weekend submissions will not be responded to until Monday and submissions during university closures will be responded to when the university re-opens.

The form will be stored in a secure digital platform and accessed only by licensed clinicians at the Campus Health Center, who will keep your information confidential unless for legal or safety reasons it needs to be shared.

Background Information

Please provide your background information as the individual submitting this form.

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Your Full Name:

Your position/title:

Your Phone Number:

Your WSU Email Address:

Email address must be of a valid format.

Your physical address:

Time of incident:

Specific location:

Involved party 1

Your Full Name

Banner ID or Access ID

Questions

Please complete the questions below.

Are you an enrolled Wayne State University student? This field is required.

May we contact you by email? This field is required.

May we leave a voicemail message? This field is required.

May we send a text message? This field is required.

Please select your preferred ways of being contacted?

Phone call Email Text

You must make at least one selection.

Please check the issues you are seeking mental health services for:

Anxiety Depression Self-Harm Traumatic Experience Eating Disorder Symptoms Relationship Problems Academic Stress Substance Use Problems Sexual Abuse/Harassment/Stalking Adjustment Difficulties Other (fill in below)

You must make at least one selection.

Other This field is required.

WSU has several excellent training clinics on campus. They have daytime and evening hours and are free to students. Would you be interested in working with a supervised graduate student at a WSU training clinic? This field is required.

Submission