Counselling First Visit Questionnaire

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Welcome to the UTS Counselling Service

We ask that you complete the following series of questions before seeing a counsellor. This should only take between 5 and 10 minutes of your time.

You should only complete this questionnaire if you have already organised an appointment with a counsellor. We will not act upon this questionnaire if you do not have an appointment booked.

When answering this questionnaire try to reflect on the feelings, thoughts and behaviours you have experienced in the last two weeks.

This questionnaire uses a secure connection to transmit your data to the UTS server. Your responses to this questionnaire will go to a secure database and will then become part of your individual UTS Counselling Service file. Your counselling service file is confidential, as per the Confidentiality and Privacy. More information about this is under the next section "rights and responsibilities". UTS Health & Counselling administrative staff access this form to perform their duties. System administrators are prohibited from unauthorised access.

By completing this questionnaire you are agreeing to the UTS Health & Counselling Service collecting, keeping and using the personal and health information you provide, and giving the information to the counsellors employed by and contracted to the UTS Health & Counselling Service, so that they can provide you with a health service. If you do not agree, do not understand, or are not over 15 years of age, do not complete this form. Please raise this with your Counsellor, or email student.services@uts.edu.au.

We have found that completing these questions before meeting a counsellor for the first time can enhance the effectiveness and helpfulness of first appointments. Your responses can be a helpful guide to the sorts of issues and questions to be addressed in your counselling session.

If you are seeking your Counsellor's support with completing forms relevant to Academic or Administrative procedures, please complete any relevant forms, e.g. Special Consideration, before your appointment.

If you require emergency assistance, contact the Police and/or request an Ambulance by dialing 000.

You may also request assistance by contacting 24-hour crisis phone counselling:

  • Lifeline Counselling Service: 13 11 14
  • Suicide Call Back Service: 1300 659 467
  • Beyondblue Support Service: 1300 22 4636
  • Kids Helpline: 1800 55 1800
  • NSW Mental Health Line: 1800 011 511

Use of Asterix "*"

This online form uses an asterix * symbol to represent that the question is mandatory and requires you to respond to the question.

Please log in with your UTS user ID and password.

If you have not used UTS email before, you will need to activate your Account.

Acknowledgement of Country

UTS acknowledges the Gadigal people of the Eora Nation, the Boorooberongal people of the Dharug Nation, the Bidiagal people and the Gamaygal people, upon whose ancestral lands our university stands. We would also like to pay respect to the Elders both past and present, acknowledging them as the traditional custodians of knowledge for these lands.