Rutgers Counseling Clinic Interest Form

Welcome to the Rutgers Counseling Clinic!
We offer free counseling services to Rutgers students, faculty, and staff, as well as to residents throughout New Jersey.

Services are available both in person at the Rutgers Busch campus and through telehealth, providing accessible care to a wide range of clients.

The clinic is staffed by master’s and doctoral-level counseling interns who are supervised by licensed faculty, ensuring high-quality, evidence-based care while supporting the professional development of emerging counselors.
Reasons to Seek Counseling

stress, career exploration, anxiety, relationship issues, difficulty concentrating, chronic illness, anger issues, adjusting to a new country, low self-esteem, identity exploration, life transitions, feeling stuck. . . and many more!

Clinic Hours

In-person and via Telehealth

Tuesdays: 10am-6:00pm

Wednesdays: 10am-6:00pm

Ready to Begin?

Please fill out the form below, and a team member will contact you.
Full Name of Client*

First NameLast Name
Client Pronoun(s)
Ex: she/her/hers, he/him/his, and they/them/theirs
Client's Date of Birth*

MonthDayYear
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you completing this form for yourself or for someone else?*

I am completing this form for myselfI am completing this form on behalf of someone else
If for someone else, please share your name and your relationship to the client:
If completing for someone else, please share your name and your relationship to the client:

First and Last NameRelationship
Reason for Seeking Services
Tell us why you're seeking services.
How did you hear about the Rutgers SLP Clinic? (Select one)

SHP listservCAPS at Rutgers New BrunswickThe Counseling Center at Rutgers NewarkCareer Exploration and Success RutgersRutgers GlobalPhysician or Healthcare ProviderSchool or EducatorInternetFamily member or FriendOther
How would you prefer for us to contact you about scheduling? (Select all that apply)

EmailPhone callText messageOther (please specify)
Do you have a preference for how your sessions are conducted?

In-personVirtual (tele-health)No preference
Do you have any other questions or information that you would like to share?
Should be Empty:

Welcome to the Rutgers Counseling Clinic!

Reason for Seeking Services