Forms

New Client Paperwork for Counseling Sessions

All forms should be completed on the LC Health Information Portal. They can be found under Forms, Section 4: Counseling Service Forms. If you’d like to review the forms or have trouble accessing the portal, 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 four separate forms:

Some of these forms are multiple pages, so you may want to print them double-sided in order to save paper.  

New Client Paperwork for Psychiatry Sessions

Click on the link below to download our new client form for students meeting with our psychiatrist (medication evaluation and management). This form is typically required once per academic year. 

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, Health Service, Health Promotion & Wellness, and/or the Confidential Advocate), download this form:  Internal Release of Information.