UAF STUDENT HEALTH AND COUNSELING CENTER INFORMED CONSENT FOR COUNSELING

Student Health and Counseling Informed Consent for Counseling Services The following information is being offered to help you decide if you want to participate in counseling at the UAF Student Health and Counseling Center (SHCC Please ask your counselor if you have any questions.

1. Counseling can help to clarify your thoughts and feelings so that you can set goals, resolve conflicts, improve relationships and reduce/relieve distressing symptoms. It involves talking about, processing and working through concerns and problems, which at times may include tolerating uncomfortable feelings, recalling unpleasant and painful memories, or facing fears, anxiety, or anger. Your participation is voluntary, and you may terminate services at any time.

2. The purpose of your first counseling appointment is to gather information, discuss your goals for counseling and build rapport. Typically, the counselor you meet with for your first session will continue to work with you; however, if the counselor thinks a different counselor may be more appropriate for you, or if you would prefer to see a different counselor, then a referral will be made on your behalf.

3. Our services are designed to be short-term with most appointments being fifty (50) minutes. Your counselor will work with you to determine an appropriate individualized treatment plan and schedule. If it is determined during treatment that further therapeutic services are required, if presenting concerns are outside the counselor's education, training or experience, or more than our short-term model can accommodate, a counselor will assist you with a referral or exploring other treatment options.

4. The UAF consolidated student fees fund UAF SHCC. Therefore, medical appointments have no charge associated with them. During Fall and Spring semesters, counseling services beyond 6 sessions (and beyond 4 sessions during the summer) will incur a $25 fee, typically charged to the student; however, additional funding may be available to cover those additional session fees.  At present, ASUAF, Graduate Student Insurance, International Student Insurance, and Student Support Services are funding the additional session fees. Medical services beyond the appointment are subject to additional charges. For example, additional fees are associated with medications and labs.

5. UAF SHCC provides an integrated model of healthcare. This integration means that the counseling and medical providers work together through consultation with one another to provide evidence-based quality care.   

6. We ask that you check-in early enough to complete a brief survey, the Counseling Center Assessment of Psychological Symptoms (CCAPS), prior to the start of every appointment. If you are unable to keep an appointment, we request that you call 24 hours in advance to cancel or reschedule so that others can use the time. If you miss two (2) appointments without cancelling or rescheduling prior to your appointment time, you will be charged a $20.00 "no-show" fee after the second missed appointment. If you check-in more than 15 minutes late for your appointment it will be considered a "no-show", and it will be canceled with the option to be rescheduled.

7. Any student requesting that a counselor write an academic modification letter or letter for withdrawal must be actively participating in counseling services at the time of the request. No exceptions will be made unless there is an emergency which will be determined by the counselor.

8. Student Health and Counseling does not issue letters for emotional support animals (ESAs It is not within our scope of practice to assess individuals to determine disability and the need for a service animal as an accommodation. We will be happy to assist you with referrals for resources that are available to you.

9. Your right to and the limits of confidentiality are discussed in the UAF SHCC Notice of Privacy Practices. In most cases, a signed authorization is required before health care information can be disclosed to individuals outside of SHCC.

Some cases in which the law dictates that your signed authorization may not be required to release information are:

*if you are considered a harm to yourself and/or another person

*if there is cause to believe a minor has been or may be abused or neglected

* if there is cause to believe that an older adult or person with a disability has been or may be abused, neglected, or subject to financial exploitation

*if your records are requested by a valid subpoena or court order

By signing below, you are indicating that you have read this document, understand its contents, and consent to participating in counseling services with SHCC. You have the right to discuss this information with a counselor at any time. Please indicate below if you consent to receiving counseling services.

Please indicate if you understand by initialing below. You may discuss this information with a counselor at any time.

UAF is an AA/EO employer and educational institution and prohibits illegal discrimination against any individual: www.alaska.edu/nondiscrimination/.