CAPS Appointment Request

In a mental health emergency do not complete this form. Call:

CAPS On-Call at 610-328-7768 or Public Safety at 610-328-8333
The National Suicide Prevention Hotline: 800-273-8255
988 - National Suicide and Crisis Lifeline
911

If you have never been to CAPS or it has been longer than 3 months since your last appointment, please use the New Client link to make an Access Appointment.

First name: *

Last name: *

Student ID: *

What are your pronouns:

Date of Birth: *

Class Year: *

Cell phone number: *

Swarthmore Email Address: *

Emergency Contact (Must be over 21 years old)

Name *

Phone Number *

Your relationship to Emergency Contact (Sibling, parent, friend, other) *

Address

Email

Phone

CAPS Appointment Request

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Contact Information

Address

Email

Phone

CAPS Appointment Request