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UW Psychological Services and Training Center request form

Thank you for your interest in the University of Washington Psychological Services and Training Center, which includes the Marsha M. Linehan DBT Clinic, the LEARN Clinic, the Parent Child Clinic, and the CALM Clinic.

If you are having an emergency, please do not complete this form. Instead, call 911 or the King County mental health crisis line (988), or go to your nearest emergency department immediately.

Responses submitted using this form are generally viewed during regular business hours, and you can typically expect to be contacted by clinic staff within 2 weeks. If you would prefer to provide this information by phone, please call (206) 543-6511 or email clinicta@uw.edu.

Please note that the therapists in our clinics are doctoral students in clinical psychology, who are closely supervised by licensed practitioners. Since we are a training clinic, we are unable to accept insurance. We have a two-tier fee schedule based on income.

**Please note that as of December 2025, Parent Child Clinic is NOT accepting any new clients.**

*If you are a parent/guardian filling out this form for your child, please put the child's information in the "Prospective client name" section.

The therapists in our clinics are doctoral students in clinical psychology, who are closely supervised by licensed practitioners. To get high quality supervision, sessions are recorded and stored temporarily in a HIPAA compliant way for training purposes.

Would you be open to seeing a student therapist?

* must provide value

Yes

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Prospective client's first name:

* must provide value

Prospective client's last name:

Prospective client's age:

Prospective client's gender and gender pronouns:

Are you a parent/guardian filling this form out on behalf of your child?

* must provide value

Yes

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Parent/Guardian's First Name:

* must provide value

Parent/Guardian's Last Name:

Parent/Guardian's gender and gender pronouns:

Phone number:

* must provide value

Email address:

* must provide value

Please indicate which type of services you are interested in:

**Please note that we are not currently offering evaluations or assessments**

Individual therapy

Couples therapy

Family/parenting therapy

Group therapy

Assessment/ Evaluation

Please indicate which of our specialty clinics you are interested in:

* must provide value

Main clinic - evidence-based therapy provided for a variety of needs in children, adolescents, and adults

CALM Clinic - evidence-based therapy for youth and adults struggling with anxiety, obsessive-compulsive-related disorders, and traumatic-stress disorders

LEARN Clinic- psychological assessment evaluations only addressing learning, behavioral, and attentional problems

What are the prospective client's main challenge areas?

*If you would prefer to provide this information by phone, please email clinicta@uw.edu.

Anxiety (e.g., worrying about a lot of different things, difficulty controlling worrying, restlessness, irritability)

Depression (e.g., persistent feeling of sadness, loss of interest, hopelessness, guilt, worthlessness)

OCD (e.g., distressing and intrusive recurring thoughts, need to perform specific actions or rituals to relieve distress)

Trauma or post-traumatic symptoms, including discrimination-related trauma (e.g., flashbacks, avoidance of reminders, constant "fight-or-flight" mode, numbness, emotional detachment)

Attention difficulties, executive functioning challenges, and/or impulsivity (e.g., ADHD)

Learning challenges, academic difficulties (e.g., dyslexia)

Developmental disability, Autism Spectrum Disorder

Outbursts, defiance, conduct issues

Relationship concerns

Family concerns

Identity exploration

Emotion dysregulation

Suicidality and/or self-harm

Other

Please elaborate on other problem areas.

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