Click on the links below to download our forms. For an appointment you need only these forms: Informed Consent and Personal Information. These forms are 4 pages each, so to save paper you may want to print them double-sided. Print two copies of Informed Consent; keep one for yourself, and bring the other to your appointment.
Download Informed Consent
Download Personal Information 2012-13Please print this form, fill in requested information, and bring the form to your first appointment. If your appointment is several days away, please complete page 4 (Student Concerns) just before you arrive.
Download Release of InformationYou may check-mark all items except the 4-part section on types of information (lower half of page). Oregon law requires that you initial (not just check-mark) this section. Be sure to sign and date the form when you have finished.
Counseling Service is located in Templeton Campus Center on the Undergraduate Campus.
Associate Dean of Students, Director of Wellness Services, and Chief PsychologistJohn Hancock
Lewis & Clark
0615 S.W. Palatine Hill Road, MSC 135
Portland, OR 97219