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Curtin University

Curtin University

 

Request For Counseling Appointment

Please provide the following information to request a counseling appointment.

Full Name
Student ID
E-Mail Address
Contact Number
Initial Appointment Date Click Here to Pick up the date


Place a check in each box that designates a time you would be free on a regular basis.

Time/Day
Monday
Tuesday
Wednesday
Thursday
Friday
 
10am
While we understand you not be free at the same time every week, indicating regular times will assist in scheduling your appointment(s)
11am
12pm
1pm
2pm
3pm
4pm


Place a tick in the box that best designates the area you would like to discuss:

Tick (/)
Area
Academic
Career
Personality
Social
Family
Marriage
Self-Development
Motivation/Discipline
Health
  Others:
All information will remain confidential!
Please note that all information shared during counselling will be kept in the strictest confidence; except where mandated by law that the University is required to divulge such information to the proper authorities.



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