Phone: 805-756-2511
Fax:     805-756-6525

8:30 AM - 4:30 PM | M-F
Building 27

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Forms and Policies

Letter Policy     Policy Regarding Animals

FORM/request Description
Release of Information Authorization to release mental health information
Outreach Request Form Request a presentation from Community Prevention & Outreach Services Team
Request for Interview Form Request interview from Campus Health & Wellbeing
No Show/Late Cancellation Fee Appeal Form Request fee cancellation because of extenuating circumstances or an error
Change of Clinician Request Form Request to change mental health provider


Letter Policy

If you require a letter from a Counseling Services mental health clinician for any reason, including documentation letters for any type of withdrawal, please note the following:

  • Letters are provided at the discretion of Counseling Services clinicians according to your clinical history, current functioning, and relevant legal and ethical statutes
  • Counseling Services clinicians follow the Americans with Disabilities Act (2009) guidelines when providing “Documentation of Psychological Impairment” forms for the Disability Resource Center (DRC)
  • Letters will be provided only in the event that a clinical relationship has been established with a Counseling Services therapist  
  • All requests for letters must be made in person at least five (5) working days in advance of when it is needed
  • You must fill out a Release of Information before a letter will be given, even if you are requesting a letter made out to yourself

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Policy Regarding Animals

Emotional Assistance Animals

Letters and other documentation for emotional assistance animals are only provided in the most rare of circumstances.  As with any letter request, you must have an established treatment relationship with a therapist.  Because there is currently no established literature base for the clinical efficacy of emotional assistance animals, it is extremely rare that a Counseling Services' clinician will support their use.

Service Animals

Counseling Services complies with all ADA requirements and accepts appropriately trained and specifically designated service animals as defined in the ADA 2010.  Please work with the Disability Resource Center if you believe you are in need of a service animal.

Types of Service Dogs may include, but are not limited to:

  • Guide Dog
  • Mobility Aid Dog
  • Seizure Alert Dog
  • PTSD Dog
  • Hearing Alert Dog
  • Diabetes Alert Dog
  • Migraine Alert Dog
  • Narcolepsy Alert Dog
  • Seizure Response Dog
  • Psychiatric Service Dog

Emotional Support Animals

In general, approved Emotional Support Animals (ESAs) are not permitted in campus buildings apart from Campus Housing. Counseling Services does not permit ESAs in the site building in compliance with Campus Administrative Policy 353. Emotional Support Animals, sometimes used as part of a treatment plan as therapy animals, are not considered service animals under the ADA.

Types of Emotional Support Animals may include, but are not limited to:

  • Companionship animals
  • Animals to relieve loneliness
  • Animals to help with depression
  • Animals to help with anxiety
  • Animals to help with certain phobias



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