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

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.  

SHIP Referral Form 2018-19