Name:

E-Mail Address:

Please tell us when you are available, along with any additional information you wish to provide. Note: This form is sent by e-mail, which is not completely secure. You may not wish to disclose any senstive information in this appointment request.

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First Appointment:

During the initial appointment, you will have the opportunity to discuss your cares, concerns and goals with a counselor. Together, you will determine what services will be best for you. If The Center for Personal Development is unable to provide the services you need, we will help you find the help you need from an outside agency.

Subsequent Appointments:

To help you be successful in reaching your goals, you must actively participate in working toward your goals, completing any assignments and openly discussing issues. The Center for Personal Development provides short-term individual counseling, at no charge, on multiple issues and concerns, including but not limited to:

• Self-esteem
• Substance Abuse/Dependence
• Depression
• Anxiety
• Grief and Loss
• Eating Disorders
• Stress Management
• Academic pressures
• Sexuality
• Time Management
• Family and relationship problems
• Anger Management
• Attention Deficit Hyperactivity Disorder (ADHD)
• Other Mental Health Diagnosis