Counseling Services Patient Forms

  • MSUM Counseling Services wants to ensure we provide a safe, confidential setting where you can explore personal concerns and work toward achieving a better understanding of yourself. To make things easier, you’ll find forms and a description of their purpose to serve your needs effectively below.

    Form
    Description
    Description
    The information entered on this form will be routed directly to the provider the student is working with.
    Description
    This form has been created for students to authorize verbal and/or written exchange about personal information.
    Description
    This form contains important information and statements about our professional counseling services and business policies.
    Description
    This form is for students to provide information about what they are experiencing as part of the reason in seeking services from a provider in Counseling Services.
    Description
    This form is for students interested in scheduling a virtual meeting or phone call with a mental health provider within Counseling Services.
    Description
    This form has been created for students to signify consent to engaging in tele-visits and tele-counseling with a provider at MSUM Counseling Services as a student of MSUM in accordance with the expectations and guidelines listed on the form.