Consent Form for Individual Counseling and Online Guidance Counseling(Applicable from 20230109)
Consent Form for Individual Counseling and Online Guidance Counseling
Counseling Center, Student Affair Department, National Tsing Hua University
Hi, welcome to the counseling center! Please read the following information and regulations carefully and sign the form in the end before accepting our service. If you have any questions or concerns, please feel free to contact us. We will be happy to explain and discuss it with you.
I. Client of Service:
The Center provides individual counseling to NTHU students. If physical courses are suspended in NTHU due to the pandemic, the Center provides online guidance counseling for NTHU students instead (see Note 1). All these services are free of charge.
II. Counseling Frequency and Duration:
Each counseling session is typically about 50 minutes and once per week. In principle, the number of interviews per semester is limited to 8 (including leave). If there are special circumstances, we may make certain adjustments after professional consideration.
III. Counseling Cancellation:
If you cannot attend the counseling session, please call, e-mail, or come in person to cancel the meeting at least 24 hours ahead. The counseling sessions will be terminated if you do not show up for two times (including leave) without an acceptable reason. (Tel: 03-5715131 Main Campus Ext. 34725 and Nanda Campus Ext. 76602; E-mail: Main Campus firstname.lastname@example.org and Nanda Campus email@example.com)
IV. Service Providers:
1. The Center will arrange your interviews with one of the professional guidance counselors, which include counseling psychologists, clinical psychologists, social workers, psychiatric specialists, and trainee psychologists (see Note 2).
2. In order to avoid confusions by receiving different treatments, the Center will arrange only one professional guidance counselor at a time to talk with you. But you have the right to seek opinions from other psychological or medical professionals.
V. Confidentiality and Exceptions:
Your information and counseling records will be kept confidential within the Center, and will be handled and stored as a confidential document. The Center will disclose it to other parties only after receiving your consent. However, the following two special situations are exceptional for confidentiality. In these situations, the professional guidance counselor will notify or provide relevant information to other parties when necessary (see Note 3).
1. If there is a danger of harm to yourself and/or another person’s life, freedom, property, and/or safety.
2. Involvement of legal obligations, such as: Children and Youth Welfare Act, Sexual Assault Crime Prevention Act, Domestic Violence Prevention Act and etc.
VI. Online Guidance Counseling:
1.Care and counseling for students during the pandemic are uninterrupted at all school levels. Issued by the Ministry of Education on July 1, 2021 "Reference principles for Online Care and Guidance Counseling at all school levels and student counseling centers during severe and specific infectious diseases.
2. Online Care and Guidance Counseling is only applicable to counselors of schools and student counseling centers at all levels during the period when the Central Epidemic Command Center declares a serious special infectious disease epidemic at level 3 or higher and students are absent from school.
3.Before starting online guidance counseling, please show your student ID (or ID card with photo) in front of the video camera for the professional guidance counselor to verify your identity.
4. Both parties should arrange themselves to be in an independent, safe and sound-proofed environment. The professional guidance counselor must know your location and emergency contact information before the online session is provided. If it is found that the environment cannot meet the needs of online guidance counseling, the service may be stopped at any time.
5. We recommend using the University's @gapp account for Communication software of Online Guidance Counseling. (for details, please refer to https://net.nthu.edu.tw /2009/gapp). It is not recommended to use public or free WiFi networks for privacy reasons.
6. Unless agreed by both parties, there should not be screenshots, audio recordings, video recordings, allowing others to watch from the side, conducting live webcasts, and/or other similar activities to protect your privacy. If the relevant circumstances are still invalid after reminding or dissuading, the session may be stopped immediately. The Center may also seek legal process to deal with related disputes.
7. If the online service is disrupted due to audio/visual equipment or internet issues, both parties have the right to interrupt the session and use other methods (such as telephone) to discuss make-up plans.
8. If an emergency occurs during the online session, you should first contact the Student Assistance Division if on campus, call 119 or go to the nearest hospital if off campus. Professional guidance counselors will also notify your emergency contact person as appropriate.
VII: Video/Audio Recording:
To provide you a better service or for the professional supervision purpose, our professional guidance counselor may request for an audio/video recording of the session. They will inform you and ask for your permission in advance. You have the right to agree or refuse the request. The professional guidance counselor will destroy the audio/video records by themselves after supervision.
VIII. Termination of Service:
You have the right to end the counseling session, but please discuss the termination with your professional guidance counselor in advance.
IX. Referral Service:
To provide you a better service, your professional guidance counselor may refer you to another professional guidance counselor or psychiatrist who can assist you better. They will ask for your agreement before the referral. If you agree, all your personal information and counseling records will be transferred too. If you ask for a referral, you will also need the agreement from your professional guidance counselor in advance.
X. Record Destruction:
Your counseling records (included personal information, psychological tests, counseling records etc.) will be completely destroyed by the Center after 10 years from your final counseling session.
1. Both parties agree not to discuss or to share the content of the session on social media.
2. If you apply for the counseling based on special needs or learning purposes, please let us know in advance.
3. If you have any questions or comments about the process of the service, you can directly discuss it with your professional guidance counselor. You are also welcome to use our Service Satisfaction Feedback Form of NTHU Counseling Center and express your opinions in anonymous.
1. The online guidance counseling is based on "Reference Principles for Online Care and Guidance Counseling for Schools at All Levels and Student Guidance Counseling Centers during the Period of Severe Pandemic Outbreak (Chinese version) " of the Ministry of Education.
2. The employment of all professional guidance counselors in NTHU is in accordance with the "Student Guidance and Counseling Act (English version)" of the Ministry of Education and the "Psychologists Law (English version)" of the Ministry of Health and Welfare.
3. The Center's confidentiality measures and exceptions are based on the laws and ethics codes of professional counselors. You can refer to the "Laws and Regulations (English version)" on the Center's webpage for further information.
I have carefully read through this consent form, and agree to accept the counseling service provided by the Counseling Center. ◻ Agree. ◻Disagree
Student ID: Date: Signature:
Professional guidance counselor:
20230109 approved by Executive Council
Applicable from 20230109