Book a counselling appointment, Help and Support, La Trobe University

	Only Occasionally	Sometimes	Often	Most or all of the time
I have felt tense, anxious or nervous	1	2	3	4
Talking to people has felt too much for me	1	2	3	4
I have felt panic or terror	1	2	3	4
I made plans to end my life	1	2	3	4
I have had difficulty getting to sleep or staying asleep	1	2	3	4
I have felt despairing or hopeless	1	2	3	4
I have felt unhappy	1	2	3	4
Unwanted images or memories have been distressing me	1	2	3	4

	Most or all of the time	Often	Sometimes	Only occasionally	Not at all
I have felt I have someone to turn to for support when needed	0	1	2	3	4
I have felt able to cope when things go wrong	0	1	2	3	4

Privacy and Confidentiality

La Trobe University respects the privacy of your personal information. We collect personal information about you to register and identify you with our counselling and wellbeing 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 on privacy@latrobe.edu.au. The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy/

Once your request is submitted we will do our best to contact you within two working days to make an appointment. Waiting times for counselling may vary depending on your campus.