Informed Consent Counseling Form for Students
This file contains the informed consent form for counseling services at Chadron Nebraska State College. It outlines patient rights, therapist responsibilities, and important counseling details. Ideal for students seeking mental health support and guidance.
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How do I fill this out?
To fill out this form, read each section carefully to understand your rights and responsibilities as a client. Ensure you provide accurate information and ask your therapist any questions you may have. Finally, sign and date the form where indicated.

How to fill out the Informed Consent Counseling Form for Students?
1
Read the informed consent form thoroughly.
2
Ask your counselor questions if any section is unclear.
3
Provide accurate information as requested.
4
Sign the form to indicate your consent.
5
Keep a copy for your records.
Who needs the Informed Consent Counseling Form for Students?
1
Students seeking counseling services need this form to understand their rights.
2
New clients at the counseling center require this form to initiate services.
3
Parents of minor students may need it for access to their child's records.
4
Administrative staff might need it to guide students on consent requirements.
5
Counselors in training need it to understand client rights and responsibilities.
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What are the instructions for submitting this form?
To submit this form, please bring it to your next counseling session or send it to the counseling center via email at counselingcenter@csc.edu. For fax submissions, use the fax number (308) 432-6233. You may also submit it in person at the counseling center located at 1000 Main St, Chadron, NE.
What are the important dates for this form in 2024 and 2025?
For students in 2024, the academic calendar deadlines apply, including counseling registration dates. The next review of this consent may occur by end of 2025. Make sure to stay updated on college announcements regarding any changes.

What is the purpose of this form?
The purpose of this informed consent form is to outline the rights and responsibilities of clients in counseling services. It ensures that clients understand the nature of counseling, its benefits, and limitations. By signing this form, clients give their consent for treatment and acknowledge their understanding of the therapeutic process.

Tell me about this form and its components and fields line-by-line.

- 1. Personal Information: Name, contact details, and other identifying information.
- 2. Consent Agreement: A clause that clients must read and agree to for proceeding with counseling.
- 3. Rights Acknowledgment: Acknowledgment of rights as a client being outlined in the form.
What happens if I fail to submit this form?
Failing to submit this form may hinder your access to counseling services. It is critical for establishing a therapeutic relationship and ensuring proper care. Consequently, delays in treatment may occur.
- Delayed Access to Counseling: Not submitting the form prevents you from starting therapy.
- Misunderstanding of Rights: Failure to acknowledge rights may lead to confusion during your treatment.
- Lack of Confidentiality Agreement: The absence of a consent form can jeopardize your confidentiality.
How do I know when to use this form?

- 1. New Client Registration: Used by new clients before starting counseling services.
- 2. Referrals: Necessary for those referred by administrators or professors.
- 3. Counselor Documentation: Helps counselors maintain legal and ethical standards.
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