Most students will complete all the forms they need as part of the process of linking with the Counseling Center, but below are some additional forms used in special circumstances. 

Release of Health Information

At the Counseling Center we take your confidentiality extremely seriously.  Legally, we must have a Release of Health Information form when you want to authorize the Counseling Center to share information with another office/person.  (We also accept release forms from other offices as long as they are similar.)  Complete it carefully, including checking the boxes for what information you want to be released.  An accompanying note should provide clear directions for which counselor to give the form to and why the information is being requested.  Call 716-878-4436 with any questions.  Please note:

  • Unless a counselor expects to receive this form from you, they may want to reach out to you directly to verify that it is actually you who submitted it and that it seems unlikely to cause you harm by releasing the information.
  • Requests for records can take up to a week to respond to, especially during busy times or if there are many records that need to be reviewed.
  • We do not recommend submitting any documents via email, as it is not a secure medium.  The most secure ways are to hand/mail deliver to the Counseling Center or fax us at 716-878-3003.  However, if you choose to use email it can be returned to  

A blank Release of Health Information form is available here.  This is a fillable PDF which can be completed electronically or printed and completed by hand.

Consent for Treatment of a Minor

Occasionally students start college and access Counseling Center services before they turn 18.  In these instances, we talk with each student about our need for consent from a parent or legal guardian.  A parental consent form is available here that outlines the roles and responsibilities of the student, parent, and Counseling Center.  Once a student reaches the age of 18, they are in charge of their health information and will be asked to complete a new consent as a legal adult.

A blank parental consent form is available here.  This is a fillable PDF which can be completed electronically or printed and completed by hand.