Forms
Upon your first visit to UCS or its divisions of Collegiate Behavioral Health and Prevention & Recovery Services, students will be asked to complete all the forms in the section: Counseling Forms. Students who are returning to the UCS after 12 months or longer will also be asked to complete them as well.
Students should plan to arrive 15 minutes before their scheduled appointment to complete them. Alternately, students may download and bring the completed forms to the UCS prior to the appointment. For privacy and security reasons, UCS discourages transmission of confidential material over the Internet.
Counseling Forms: Initial Visits to the UCS, CBH & PRS
- Consent for Treatment Form [PDF, 477KB] — This form includes important information regarding confidentiality, privacy, and what a student can expect from counseling at UCS.
- Personal Data Form [PDF, 372KB] — This form will help us learn more about those seeking our services.
- Student Concerns Questionnaire — This is a survey designed to help students and our counselors identify counseling concerns and help students generate goals for self-improvement.
The UCS recommends completing the Student Concerns Questionnaire no more than 24 hours prior to your scheduled intake appointment. It is important to note that UCS Staff cannot review your responses until you bring the paperwork with you to the scheduled appointment. If you are in a life-threatening situation now, call the UCS at 216.368.5872 or go directly to the nearest hospital emergency room.
Optional Forms: Release of Information and other forms
- Authorization or Release to Access Information [PDF, 123KB]
- Parental/Custodial Parent Authorization to Provide Treatment [PDF, 65KB] — This form is ONLY for students who are under the age of 18.