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Student Health Center : Counseling Center : Forms

Forms

Here is a Listing of Many of the Forms Commonly used or Requested at the Counseling Center.

Appointment Request Forms

Read this information on how to schedule your first appointment and a description of our services. Please DO NOT complete these forms and FAX them to the Counseling Center as a way to initiate a first appointment.
(You can save some time at the Counseling Center by dowloading these forms and have them already completed when you arrive at the Center to schedule your 1st appointment, but do not send us the forms as a means of establishing a first contact. We still prefer students to come to the Counseling Center to set up their appointments.)
 
Word Document
.pdf File
Appointment Request Form
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Consent Form
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Schedule Card
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Academic Withdrawal Forms

Information about the Withdrawal Process
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Off-Campus Withdrawal Application*
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* This is only for students who are unable to come to campus.
 

Alternative Readmission Program Forms

Explanation of ARP Procedures
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Student Questionnaire
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Student Questionnaire for Off-Campus Evaluation
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Student Forms for Health Providers

Release of Information
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Health Provider Letter
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Provider Forms

Individual Provider Questionnaire
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Agency or Group Practice Questionnaire
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Group Therapy Provider Questionnaire
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Student Appeal Forms

Appeal form for No Show Appointment Fee
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Counseling Center
2815 Cates Avenue
Campus Box 7312
Raleigh, NC 27695-7312
919.515.2423
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last updated 7/12/04

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