- Student Health & Counseling Services
- Hours of Operation
- PATIENT RIGHTS & RESPONSIBILITIES
- Appointments
- Immunization Requirements and Recommendations
- After Hours & Emergency Care
- Quick Links
- About SHCS
- List of Services
- Hayward Clinic
- Concord Clinic
- Counseling
- Forms
- hipaa Privacy Practices
- Other Related Information
Forms
General
- Request to Release Records
- Authorization to Release Information
- Authorization to Disclose Mental Health Information
- Minor Consent Form
- Safety planning resources:
- Strength-Based Safety Plan (Adapted by Dr. David Emmert)
- Personal Crisis Plan (Wellness Recovery Action Plan from )
- SAGE Response to a Psychosocial Crisis (developed by )
- Sample Advance Mental Health Directive
Psychiatry
- Authorization to Disclose Mental Health Information
- Informed Consent to Receive Psychiatric Treatment
- ADHD Treatment Policy
- ADHD Medication and Controlled Substance Agreement
- ADHD Treatment Instructions
- Documentation of Previous ADHD Treatment
- Diagnostic Interview for ADHD in adults (DIVA) 2.0
- ADHD Assessment Process and Referrals
- Guide to Finding a Psychiatrist in the Community
- Free and Low-Cost Psychiatry Referrals
If you have any questions, please call (510) 885-3735 or email shcs@csueastbay.edu.