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Schedule an Appointment

Once you have an appointment with Student Emergency Services be sure to bring all pertinent documentation to your appointment (doctor's note, obituary, bills – if applicable).

Items marked with * are required fields. Please enter "N/A" in fields that are not applicable.

If you have met previously with Student Emergency Services staff to discuss this EXACT issue, complete only the UT EID, Name, Date of Birth and updated problem description. If no other information has changed, you may enter "N/A" in the remaining fields.

Contact Information

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*Parents or guardians occasionally contact Student Emergency Services with questions about a particular client matter. Do you authorize us to discuss your case with your parents or guardians? (You may modify this consent at any time by notifying us in writing.)  


Appointment Dates

List 3 preferred appointment dates / times (MUST be at least 24 hours from now). Student Emergency Services hours of office operation are Mon.-Fri. 8 a.m.-5 p.m. excluding school holidays and closures. Walk-In appointments are available if necessary (SSB 4.104)

* Appointment Date, First Choice:

* Appointment Date, Second Choice:

* Appointment Date, Third Choice:

Acknowledgement

I understand that email correspondence may not be confidential. If I choose to correspond with this office via email, I do so at my own risk and I agree that this office will not be responsible for any unauthorized interception of such email message(s) by third parties. I also waive any objection to any potential breach of my confidentiality or privacy that may occur if the office responds to my email.

I have read and understand the information provided about the policies and procedures of Student Emergency Services.

*