Forms

Counseling Service

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 2012-13

Please 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 Information

You 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.

Contact Us

Counseling Service is located in Templeton Campus Center on the Undergraduate Campus.

Emailcounsel@lclark.edu

Voice503-768-7160
Fax503-768-7115

Associate Dean of Students, Director of Wellness Services, and Chief PsychologistJohn Hancock

Counseling Service
Lewis & Clark
0615 S.W. Palatine Hill Road, MSC 135
Portland, OR 97219