UQ With You - Initial Contact Form

UQ With You provides high quality, short term counselling services via telehealth (phone or videoconferencing) to support community members with a wide range of life difficulties and issues. UQ With You aims to make therapy more accessible to members of the community by providing no-cost therapy that can be accessed from the comfort of your own home. You do not need a referral to access this free service.

Important to Note: The UQ With You service is a student-led service, staffed by provisional psychologists and counsellors undergoing advanced postgraduate training, who are supervised by fully registered psychologists and counsellors. We do not accept referrals for high risk clients, actively psychotic clients, or students currently undertaking postgraduate psychology or counselling studies at UQ

CLIENT DETAILS

Please enter your own details only; do not complete this form on behalf of someone else. If you believe UQ With You would be helpful to someone else, please share this link with them so that they can complete the form on their own behalf.

First Name*

Last Name*

Email*

Phone*

Are you over the age of 18?*

Yes

Gender*

Male

Female

Other

Prefer not to say

How did you hear about UQ With You?

DISCLAIMERS

Please read and acknowledge the following disclaimers to ensure you can be added to our waitlist in a timely manner. If you are unable to check off one or more of the following, we may need to offer you other referral options:

I understand that (please tick boxes):*

The UQ With You service is a student-led service.

Sessions may be recorded for training purposes only. These recordings are kept private and confidential for the purposes of therapist training only and are deleted on a regular basis. We will always tell you if we are recording your session.

Provisional psychologists and counsellors-in-training are not considered experts in the eyes of the court‚ so cannot write reports or provide evidence for any legal matters. We provide supportive counselling for stress relating to legal matters‚ but cannot provide legal advice.

I understand that UQ With You is staffed by student therapists and that their availability may change over time. In some circumstances‚ this may mean I need to change therapists or be referred on to another service. However‚ in either of these cases‚ UQ With You will make every effort to ensure continuity of care.

I understand that UQ With You may contact me by phone‚ email‚ or SMS. By submitting this form‚ I certify that it is safe for UQ With You to contact me by any of these means. PLEASE NOTE: If contacting you by any of these means could put you at risk of violence or abuse‚ please contact 1800 RESPECT (1800 737 732) rather than UQ With You.

Privacy notice: The University of Queensland complies with Australian and Queensland privacy laws and guidelines. Information supplied by you will only be used for statistical purposes, to evaluate this activity and to administer your enquiry. The information collected is confidential and will not be disclosed to third parties without your consent, except to meet government, legal or other regulatory authority requirements.