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Appointment Request Form

 

Providence EAS is committed to scheduling appointments that are as convenient as possible for you and near your work or home.  There are several ways to schedule an appointment.  You can call our office at (800) 216-7867 or (360) 493-7867.  Or, you can submit an online request by filling out the form below.  Important: Please indicate in the comment section if you have a preference for a female or male counselor.

Disclaimer:  Requesting an appointment is a very important step in seeking help.  However, if you are experiencing a medical emergency or crisis, please call 911.  If you are experiencing a mental health emergency or crisis, please call (360) 586-2800 for the Crisis Clinic of Thurston County, or (360) 493-7999 for Crisis Services of Providence St. Peter Hospital.  Both of these agencies are staffed 24 hours per day, seven days per week.

First Name

Last Name

E-mail Address
(optional)

Day Phone


Can we leave a message?
yes no

Evening Phone


Can we leave a message?
yes no

Preferred appointment location

 Best time to
reach you

Comments