Client Intake Sheet
Counseling Center Alert Box
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Counseling Center Client Intake Info & Disclaimer
WARNING: If you believe you are a danger to yourself or others outside of normal business hours (M-F 8:00 am-4:30pm), please call the Crisis Hotline (1-800-273-8255), VUPD (812-888-5555), or 911.
These forms will NOT be routinely checked outside of business hours (M-F, 8:00 am - 4:30 pm) or during University Holidays/closures.
Should you not attend your appointment, these forms will be discarded.
The Client Intake sheet is to help us learn more about you and to gather basic demographic information. Please check your typing and answers so that we have the correct information, paying special attention to your email and phone number so that we have a way to contact you in order to complete the scheduling process.
Once the Client Intake Sheet is submitted and information has been verified, the Counseling Center would like to speak to you to discuss the additional forms that will need to be completed and schedule an appointment. The additional forms include the Statement of Rights, and the Teletherapy Consent for Services.
We look forward to meeting you!