Welcome to the Center for Health and Wellness (CHW) online counseling inquiry form. This form is for students who are seeking counseling services through the CHW for the first time, and would like to request an appointment and/or more information about counseling services.
If you are experiencing a mental health crisis (thoughts of hurting yourself, others, or property, disorientation, inability to communicate or think clearly due to your intense emotional state), do not complete this form, and call 911 or the Law School Security Desk at 614-236-6161. If you would like to talk with someone immediately, contact the CHW at 64-236-6114. We are open from 8:30-5:00, M-F. Outside of CHW hours, you may call Columbus Suicide Prevention Services at 614-221-5445, who has staff available 24/7.
After submitting this form, the confidential information you enter will be emailed to Shirley Lange, Ph.D., Psychologist, and Stacy Ingraham, MSEd., Professional Clinical Counselor, who are the two full-time mental health treatment providers at Capital University's CHW. You will be contacted by a staff person at the CHW within 24-48 hours to schedule your appointment. Please enter the following information:
How would you like to be contacted? (You may check both).
Phone May CHW leave a voicemail?
Capital University Law students may seek counseling services at the Law School counseling office in room 562 or at the CHW in Bexley (approximately four miles from the Law School).
Capital University Law School
The Center for Health and Wellness in Bexley
Please Note: The CHW makes every attempt to keep electronic communication confidential; however, the confidentiality of electronically transmitted communication cannot be guaranteed.
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