Forms

The following forms may be helpful prior or subsequent to your visit at CAPS.

Minors (17 Years and Younger)

UNLV students who are minors (17 years and younger) cannot be seen at CAPS without a signed consent from their parent or legal guardian. A Student Wellness Center Consent for Treatment form must be signed by the student’s parent/legal guardian and notarized or witnessed by a Student Wellness staff member before or at the time of your first visit.

No Show Appeal Form

If you need to cancel your CAPS appointment the day of, or if you no call/no show for your appointment, a fee will be charged to your account. If you would like to appeal a no show or cancellation fee, please access and submit the No Show Appeal Form.

Release of Information Form

All communication at CAPS is confidential, meaning that conversations with therapists stay in CAPS (exceptions include imminent risk of harm to self or another, or mandated reporting concerns). If you would like CAPS providers to communicate with someone outside the center, please complete the Release of Information (ROI) form.

Student Health Center Forms

The Student Health Center Forms may be useful in assisting your visit to the Student Health Center (SHC) or Faculty and Staff Treatment (FAST) Center.

Voluntary Health Withdrawal (VHW) Form

UNLV students may apply for a Voluntary Health Withdrawal (VHW), a separation of the student from the university, if they experience medical or psychological conditions that significantly impair their ability to function successfully and safely in their role as a student. A VHW allows the student an opportunity to take time away from school and address medical or mental health concerns in a comprehensive and efficient way. For more information on the VHW process please fill out the Voluntary Health Withdrawal (VHW) form.