Division of Student Affairs > Student Services > Counseling > DePaul UCS Referred Provider Survey

DePaul UCS Referred Provider Survey

​​​​Pre-Survey Notice:

Thank you for taking the time to complete this survey.  It is for providers contacted directly by DePaul UCS. If you came to this survey through a different source, please know that unsolicited survey responses will not be processed as the DePaul UCS referred providers database is not an “open system.” Clinicians interested in being included as a potential referred provider are welcome to contact the department to request a review of their services, but otherwise will not be added without a screening.​​​​​​​​​​​​​​​​​​​​​​​​​ 

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Clinician Contact Information:

*Please note the image should be Png, Jpeg or Gif with 255 px width, 300 px height and size is not over 2 MB.

Contact Person for Referrals to Practice:

Clinician Type:

Clinician Degree:

Clinician License:

Practice Type:


Health Insurance:

Fee Structure:


Clinican Demographics:


Client Fit: