Schedule Student Counseling Appointment
Please fill out the form below to schedule a Counseling Center appointment. If you are in need of immediate assistance, please call Campus Security at 605-641-6988 or 911. If you need to talk to someone immediately please call the Crisis Care Center at 605-391-4863. On call therapists are available 24/7. If the form produces an error message, please call 605-642-6520 or email Garrett.Kohler@BHSU.edu.
Full Name
Phone
BHSU Email
The State of South Dakota legally recognizes communication between a therapist and his/her client as privileged and confidential. Your mental health records do not become part of your educational records. We will not disclose your contacts with us to your spouse/partner, your parents, professors, or anyone else without your permission. There are few exceptions:
- If you are in imminent danger to yourself or are a significant danger to someone else, we have a legal obligation to break confidentiality to protect you and/or others.
- Your records can also be subpoenaed by a court of law
- If you are abusing children or vulnerable adults or inform us concerning someone who is, then we have a legal responsibility to report this to the proper authorities.
- We also reserve the right to consult with your primary care provider and/or other mental health professionals when appropriate.
By clicking 'I agree', I indicate I have reviewed the Confidentiality Notice. I understand the risks and benefits of tele-mental health and have had my questions regarding the procedure answered. I hereby consent to participate in a tele-mental health visit under the conditions described in this document.
I agree
Zoom, Telephone, or Face-to-Face?
Zoom
Telephone
Face-to-Face
Telehealth Consent Form
*Please download and fill out the Telehealth Consent Form below:
Download Telehealth Consent Form Here
Upload (PDF) Telehealth Consent Form HERE!
Have you seen a counselor at BHSU previously?
Yes
No
Are you scheduling an OPTIONS (BHSU Drug and Alcohol Abuse Prevention Program) appointment?
Yes
No
When would you like to see a counselor?
This is an emergency
Today or tomorrow
This week
Next week
Would you like a workshop or presentation?
Yes
No
Please list 3-4 dates and times that you are available
Special information or comments you would like us to know about:
Comments, Questions, Concerns?
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