Request a Mental Health Therapy Appointment

Request a Mental Health Therapy Appointment
Type of Appointment

Self-Care Check-In45-minute Individual Counseling
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Student or Staff Member*

StudentStaff
Campus*

GBAGBNGBOGBS
Glenbrook ID Number*
Preferred Mode of Communication to Receive Outreach/Scheduling Information:*

TextEmailNo Preference
Appointment Inquiry*

First AppointmentFollow-Up - I have attended a therapy session at the GSHC before
Preferred Appointment Type*

In-PersonVirtualNo Preference to In-Person or Virtual Visit
Availability of Appointment (check all that apply)

Before SchoolAfter SchoolGold Block 1Gold Block 2Gold Block 3Gold Block 4Blue/Green Block 1Blue/Green Block 2Blue/Green Block 3Blue/Green Block 4
If you are comfortable, please share anything, including symptoms or problematic experiences, that will prepare for our session. This question is not required.
Insurance Information (we do not bill for these services, however, is helpful for accessing resources)

MedicaidPrivate InsuranceI am unsure
How did you hear about mental health services at Glenbrook School Health Center? (check all that apply)

Doctor/ProviderSchool StaffFriendOnline SearchMarketing Event
For 15-minute Self-Care check-ins, please stop by the Health Center to request an appointment. Typically there is same-day availability.

Give yourself fifteen minutes to rest and reset with a self care check-in visit. Students and staff may explore aromatherapy, meditation, breathing and grounding exercises, journal, learn behavioral therapy skills, and much more.
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Request a Mental Health Therapy Appointment

For 15-minute Self-Care check-ins, please stop by the Health Center to request an appointment. Typically there is same-day availability.