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Counseling Service

Forms

New Client Paperwork

Click on the links below to download our new client forms.  These forms are typically required once an academic year.  For a new appointment you will need to complete three separate forms:

Some of these forms are multiple pages, so you may want to print them double-sided in order to save paper.  Print two copies of Information About Our Services; keep one for yourself, and bring the other to your appointment.

 

Release of Information Forms

The Counseling Service adheres to very strong privacy guidelines.  If you wish to request that information about your counseling records be released, look at the options below to determine which form best meets your needs.  

To release information about your counseling records to off-campus individuals, download this form: Authorization to Use and Disclose Protected Health Information. 

To request that information about your counseling records be shared with other offices on campus, download this form: On-Campus Release of Information

To request that information about your records be shared within Wellness Services (Counseling, Student Health, Health Promotion & Wellness, Case Management and/or the Sexual Assault Response Advocate), download this form:  Internal Release of Information.

 

 

 

Counseling Service

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