Forms

Electronic Paperwork & CCAPS

For your convenience, UH&CS Counseling Services has transitioned to all electronic paperwork which you can complete on your mobile device, your lap top, your tablet, or on a computer made available to you at Counseling Services. Electronic paperwork will not be accessible to you until you have checked-in with Counseling Services front desk staff. Instructions for completing the electronic paperwork will be provided to you upon check-in.

At your first visit to Counseling Services, once you have checked in at the front desk, you will be asked to complete an electronic survey and a clinical questionnaire. These are accessible through the My Health Connect portal and require the use of your Case Network ID.

What forms do I have to complete?

The first time you come to Counseling Services, or if you've been away from us for at least 3 months, you will need to complete all of the initial paperwork. This will likely take you between 10-15 minutes to complete. Paperwork to complete when establishing care at Counseling Services includes:

  1. UH&CS Privacy Notice (Annual notice which may be completed anytime)
  2. Consent For Treatment and Initial Questionnaire
  3. CCAPS 62 Survey
What is the CCAPS?

You will be asked to take a short survey, called the CCAPS (Counseling Center Assessment of Psychological Symptoms) at the beginning of EACH counseling appointment. It is important that you complete this survey based on how you have actually been feeling for the past 2 weeks. This information will help shape your ongoing work with your counselor at Counseling Services.

The first CCAPS you take will have 62 questions and it should take you about 7 to 10 minutes to complete.

At each subsequent appointment, you will be asked to complete the shorter version of the CCAPS, which only consists of 34 questions and typically takes between 2 to 3 minutes to complete.

Optional Forms: Release of Information and other forms
  1. Release of Information [PDF, 84KB]
  2. Parental/Custodial Parent Authorization to Provide Treatment [PDF, 65KB]—This form is ONLY for students who are under the age of 18.
  3. ADHD Documentation and Prescription Policy [webpage]—Describes documentation and/or assessment required to receive a prescription for stimulant medication through UHCS.