Counseling Center

University of Mississippi

Telemental Health Services Consent Form

*DO NOT complete this form unless you have been directed to do so by a UCC staff member.    

Due to our office providing telemental health services at this time, the UCC is asking existing clients and new clients to complete our Telemental Health consent form for mental health services.  

  • Step 1: Please click HERE to download the Telemental Health Consent Form 
  • Step 2: Please read the form, fill it out completely, and save it.
    • Please fill out ALL of the information requested and note initials at the end of each page
  • Step 3: Please upload your completed form into the following link: Telemental Health Document Repository 
  • Step 4: Once completed, please call the UCC at 662-915-3784 to schedule your appointment.
  • PLEASE NOTE: A Telemental Health Informed Consent Form must be completed and
    submitted before you are able to schedule an appointment. 

If you have any questions about this process, please email or call the UCC for guidance.

Attachments and links included on this page: