CONSENT FORM FOR STUDENTS PARTICIPATING IN CONSULTATION SERVICES PROVIDED BY THE WELLNESS CENTER
Wellness Center staff is here to provide you with support during these times. Consultation session are brief, lasting about 15 to 20 minutes long. These sessions do not constitute as mental health treatment. Should you need speak to counseling staff for further consultation, you are welcome to schedule another appointment. Please note that referrals to providers near you may be recommended for optimal care.
Confidentiality: Communications between a student and Wellness Center staff cannot be shared with anyone, within or outside the University, without your verbal or written consent, unless one of the following arises:
- There is clear and imminent danger to an individual or the public, or cause to believe that there is a likelihood of danger to a person(s).
- There is clear and imminent danger or likelihood of danger to yourself.
- There is reasonable cause to believe that a child (under age 18) has been subjected to acts of abuse/neglect (physical, sexual or emotional), or if there is reason to believe that these acts will occur
These exceptions to confidentiality are rare. If disclosure of confidential information does become necessary, whenever possible, we will discuss with you any action that is being considered.
I HAVE READ THE ABOVE MATERIAL REGARDING THE RIGHTS OF CONSULTATION SERVICES UNDERSTAND ITS PROVISIONS. BY AGREEING TO SPEAK TO A COUNSELOR I AM VERBALLY CONSENTING TO THESE TERMS.