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.

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.

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.

• 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.

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.

• 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.