WC RS Confidential Info Form - Westmont College 2025

1. Click ‘Get Form’ to open the WC RS Confidential Info Form in the editor.
2. Begin by entering your name and today's date at the top of the form. This ensures that your information is current and accurately recorded.
3. Fill in your birth date, age, and sex. This demographic information helps the counseling center understand their student population better.
4. Check all applicable boxes under ethnicity and relationship status. This section is important for understanding diverse backgrounds.
5. Provide your Westmont residence details and home address. Ensure accuracy for any necessary correspondence.
6. Enter your cell phone number and email address, indicating whether you permit contact via these methods.
7. Complete the emergency contact section with a name, relationship, and phone number for safety purposes.
8. Proceed to medical information by answering questions about your physician, insurance carrier, hospitalization history, and substance use if applicable.
9. In the counseling concerns section, describe any issues prompting your return to counseling and rate your distress level on a scale from 1 to 10.
10. Finally, review all entries for accuracy before submitting the form through our platform for secure processing.

Start filling out your WC RS Confidential Info Form today using our platform for free!