Same-day Peer Mentor Appointment

Please note: Information you provide is voluntary and protected as confidential data. You can also request an appointment by phoning 905.721.3392 or emailing studentlifeline@ontariotechu.ca.

Same-day Peer Mentor appointment schedule:

Mondays | 4 to 5 p.m.
Tuesdays | 9 to 10 a.m.
Wednesdays | 5 to 6 p.m.
Thursdays | 1 to 2 p.m.
Fridays | 10 to 11 a.m.

If you require urgent assistance, use one of the following:

Off-campus:
Call 911
On-campus:
Call Campus Security at 905.721.3211
Help lines:
Crisis Services Canada at 1.833.456.4566
Good2Talk at 1.866.925.5454

Name Name First Last
Email
Student number
Must be 9 digits. Currently Entered: 3 digits.
Phone Phone - ### - ### ####
Preferred method of contact

Preferred method of contact Email Phone
If you selected phone, can we leave a message?

If you selected phone, can we leave a message? Yes No
I am at risk of suicide:

I am at risk of suicide: Yes No
If you are at risk:

If you are at immediate risk of suicide, please call 911 (off-campus) or Campus Security at 905-721-3211 (on-campus) immediately. Note that Student Mental Health Services is not a 24/7 crisis line. We will respond to requests for support within one to three business days.

If you have thoughts of suicide please complete the Mental Health Self-Referral form.
We will redirect you to a Mental Health Counsellor.
Reason for appointment

You will still have an opportunity to request an appointment with a Mental Health Peer Mentor below.
Academic stressors Accessibility challenges Anxiety or worry Eating and/or body image concerns Depression or low mood Employment or career stressors Experienced discrimination, harassment, violence, or exclusion Feeling isolated or disconnected Financial stressors Sexual violence Other Other
Have you had an appointment with us before?

Have you had an appointment with us before? Yes No
Preferred method for session

Preferred method for session Secure video appointment Telephone appointment
Personal information on this form is collected under the authority of the University of Ontario Institute of Technology act (2002), and will be used to the provision of counselling/psychotherapy at Ontario Tech. Questions about this collection should be directed to the Assistant Vice-President, Student Life, Ontario Tech University, 2000 Simcoe Street North, Oshawa ON L1G 0C5, 905.721.8668 ext. 2327

Same-day Peer Mentor Appointment

Same-day Peer Mentor Appointment

If you are at risk:

Reason for appointment