Request a men’s wellbeing appointment

During the COVID – 19 pandemic and University campus closure, you can access our services virtually by Zoom, or over the phone. This online booking portal is for non-urgent requests only.

If you are experiencing suicidal thoughts or if you are in an emergency situation, please contact the La Trobe University Crisis Line by calling 1300 146 307 or by texting 0488 884 100. Alternatively, you can contact Lifeline 24 hours a day, 7 days a week on 13 11 14.

Remember: If there is risk of imminent harm to you or someone else, call Emergency Services on 000.

Personal details
e.g. 12345678
Emergency contact details
Enrolment details
Study load *
Booking details
How are you requesting a counselling session *
Please describe
Are you currently seeing another counsellor?
Are you attending counselling as a result of sexual assault or harassment?
Referral type Multiple selections allowed
Validation

 

Confidentiality

La Trobe University respects the privacy of your personal information. We collect personal information about you to register and identify you for counselling services. If you do not complete this form, then we may not be able to provide you with counselling services. The counselling service maintains confidential records of counselling sessions to monitor and facilitate your counselling and progress. Access, collection and storage of your personal information by the University is in accordance with the Health Records Act 2001. We treat the information we receive from you with confidentiality and respect and will only disclose your information to third parties outside the University with your consent or where it is required or authorised by law. You may have the right to access the personal information we hold about you subject to any exemptions in relevant laws, by contacting us onprivacy@latrobe.edu.au The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy/

Confidentiality statement confirmation *