Personal Counseling Forms

Dear Medical Learner,

  1. To make the best use of your appointment time, please complete and bring the INTAKE QUESTIONNAIRE AND ALL CONSENT FORMS to your first appointment.

    The teletherapy consent for is provided in case we have phone contact at any time or web sessions. Please complete. The video consent is optional However, it can be an invaluable tool for your review and enhance your learning.

  2. Paperwork may take you 30-60 minutes to complete so please allow ample time before our appointment to complete.

    1. COUPLES: BOTH individuals need to complete INTAKE and CONSENT forms.


If you are unable to keep your appointment we ask for a 24 hour notice so that we can offer that time to one of your colleagues. Please email to cancel/reschedule. Include several days and times when you are available.

We recognize that your schedules are often very dynamic and make appropriate allowances. Please read the following information carefully.

The Same-Day-Call policy can be enacted if you fail to attend two consecutive sessions and give 24 hour notice. The counselor may then require that your name be placed on a “same day schedule list.” You must then call on the same day an appointment is desired and is scheduled if time permits. The counselor may take you off of the “same day schedule list” at his/her discretion. The Administrative Staff will be notified if the counselor implements or removes your name from the Same-Day-Call policy so that you may be scheduled correctly.

If you have questions during normal business hours call: 317-274-8214 and speak with the front desk and they will relay a message to me.

My location: IUPUI Student Health Services in Coleman Hall.

Coleman Hall is located on 1140 W. Michigan St. Suite 100 ( You will check in at the front desk.

For appointments AFTER 5 p.m.:

  • Call 317-278-1069 and ask to be admitted into the building.

Parking: park at any of the student/physician lots according to your entry pass. We cannot validate parking passes.

Counseling Services and Wellness' e-mail is not monitored outside of regular business hours. Do not use for emergency situations.

In Case of an Emergency after normal business hours contact any of the following:

911 or go to the nearest Emergency Room
Crisis & Suicide Hotline: (317) 251-7575
Midtown Mental Health Center (24 hours): (317) 630-8485
Aspire: (800) 560-4038