Within this page you will find useful forms that are often used within the Counseling Center. 

Telebehavioral Health Service Forms

Please find the informed consent form for Telebehavioral Health Services. Click here: Informed consent 

If you are engaging in Telebehavioral Services with the Counseling Center here is the set of instructions for how to access TAO (Therapy Assisted Online) in order to engage in telebehavioral health sessions. Our front office administrative staff will also be sending these to you prior to your appointment via Secure message in the health portal.

Click here: TAO Video Conferencing Telebehavior Health Services Instructions for Clients in the V3 Platform which is the us.taoconnect.org 

Instructions for how to complete Electronic Telebehavioral Health Services Appointment Forms 

Instructions for how to complete electronic forms for an Initial Assessment Appointment: Click Here 

Instructions for how to complete electronic forms for a 1-Session Counseling Appointment: Click Here

Instructions for how to complete electronic forms for a Case Management Appointment: Click Here

General Forms 

This form is used to release your protected health information as required by federal and state privacy laws. Your authorization allows the Counseling Center to release your protected health information to a person or organization that you choose. Please note this form will need to be handed in in person, or sent directly from another provider. 

Authorization to Release or Exchange Mental Health Information

Please find the SHIP Mental Health Referral Form below. If you are a undergraduate or graduate student with SHIP insurance and are looking for or being referred off campus for mental health services you will need to complete this form.

2020-2021 Ship Mental Health Referral Form

Due to COVID the Mental Health Referral process has changed as the Student Health Center is currently operating remotely.  

Once you have selected a therapist and made your first appointment, you need to contact the Student Health Center Insurance Office to request a referral PRIOR to attending your first appointment. Their phone number is: 949-824-2388 or you can email them at shc-insurance@uci.edu, but please note email is not a secure method of communication. You will need the name, address, phone number, and fax number (if they have one) of the therapist you are going to see.  Please try and contact the Student Health Center for the referral one week prior to your first appointment.