Discussion List for campus-based and allied personnel working to end gender-based violence on campus.

[Adriane Bang <>]

Hi Alana,

I've attached our copy; it's pretty short!  I usually provide a verbal overview and discuss the differences of the services I offer (advocacy, confidential space to discuss experiences and resources) from therapeutic treatment.

Adriane Bang, LMSW

Associate Director, Women's Center
Boise State University
1910 University Drive, Boise, ID, 83725-1335
Phone: (208) 426-4259
Website: womenscenter.boisestate.edu

On Tue, Jan 5, 2016 at 9:37 AM, Sacks, Alana <> wrote:

Hello to all in the field and Happy New Year!

I am writing to find out if anyone currently uses a version of a "consent to treat" form?  This would be a form dedicated to outlining our services  as advocacy vs. therapeutic treatment and also to delineate the breadth and limits to our confidentiality.

Does anyone currently use a form like this before meeting with students and, if so, would anyone be willing to share their template with me?

Thank you, thank you.  Apologies if this question has been addressed on this listserv already at some point.

Best to you all,

Alana

Alana Sacks, MSW, LCSW

SHARE Advocate

Brown University Health Services

BWell Health Promotion

Box 1928

13 Brown Street

Providence, RI  02912

 

Phone: (401) 863-7895

E-Mail: 

“There is no greater agony than bearing an untold story inside you.” 
― Maya Angelou, I Know Why the Caged Bird Sings

“What is to give light must endure burning.” 
― Viktor E. Frankl, Man's Search for Meaning

Attachment: Support Service Confidentiality Sheet for Adriane_Template.docx
Description: application/vnd.openxmlformats-officedocument.wordprocessingml.document