Request Our Services

Thank you for choosing the University of Evansville’s Mental Health and Wellness Clinic & Emily M. Young Assessment Center! If you're interested in our services, please submit a Service Request Form. You can either call us at 812-488-5640, and one of our aides will assist you in completing the form over the phone, or you can download, print, and drop off the completed form at the clinic's front desk.

Please note, this is NOT for emergency appointments. If you are experiencing an emergency, please dial 911 or go to your nearest Emergency Room.

New Client Service Request Form

Your Form Has Been Submitted – What’s Next?
Once you have completed and submitted your form, it will be added to our waiting list. When it's time to schedule your appointment, you will receive a call from us informing you that a counselor has been assigned to you and that we are ready to schedule your appointment.

Intake Paperwork

To help streamline your first visit, you have the option to download our intake paperwork ahead of time. Simply click the corresponding download links below, complete the forms, and bring them with you to your appointment.

View our Notice of Privacy Practices.

Language Interpretation Services

We want to ensure all our clients feel comfortable and supported. To ensure everyone has equal access to our services, we have partnered with Heartland Language Services to provide professional interpretation. This is available for both phone conversations and in-person appointments. If you need interpretation assistance, just let us know, and we will make the necessary arrangements.