Midland University Counseling Center – Informed Consent
Student Rights and Responsibilities
You have a right to seek confidential mental health counseling and can discontinue services at any time unless implemented as a condition of a behavioral sanction through administration. You are responsible for making and keeping scheduled appointments. You are also responsible for communicating issues and working toward mutually stated goals.
What Can You Expect?
You can expect to discuss any presenting issues that instigated counseling. These presenting issues can be difficult to discuss but are important in resolving them. Be prepared to discuss pertinent historical information and how it applies to present day. Also be prepared to set goals that are mutually agreed upon by student and counselor. There is no guarantee that mental health counseling will resolve all of the student’s issues, but the mental health counselor will work collaboratively with student to best address presenting issues. Mental health counselor is open to hearing feedback from student about counseling practices that are most effective for them.
Mental health counseling services at Midland University are intended for short-term, non-life threatening issues. In the event where long term counseling will be required, a referral will be made to a community resource.
Appointments
Counselor office hours are Monday-Thursday. Counseling hours are Monday and Tuesday 1:00-6:00 and Wednesday and Thursday 8:00-1:00. Counseling intakes can last up to one hour with subsequent half-hour appointments. You can make an appointment by:
1. Calling the counselor at (402)941-6027.
2. E-mailing the counselor at
Confidentiality
Counseling discussions between student and counselor are kept confidential and will not be revealed to anyone unless the student gives written authorization to release information. There are four exceptions to confidentiality:
1. In the event of clear and present danger to self or others.
2. In the event of child abuse or abuse of a dependent adult.
3. In the event of a court order.
4. In the event of appropriate inter-departmental collaboration.
Fees
There is no charge for mental health counseling at Midland University. If outside counseling is recommended, that is at the student’s expense. Also, if psychiatric or medication management services are required, that is also at the student’s expense. Please notify the counselor if you cannot make your appointment in order for someone else to utilize that time slot.
Limitations
The Midland University Counselor reserves the right to discontinue services at any time.
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Signature of Student: ______
Date: ______