麻豆传媒社区入口

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  • Forms
    • adhd-treatment-policy-revised-6-24-25.pdf
    • controlled-substance-agreement-revised-6-24-25.pdf
    • adhd-instructions-revised-6-24-25.pdf
    • authorization-to-disclose-mental-health-information-form-edited.pdf
    • authorization-to-disclose-mental-health-information-form-edited1.pdf
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  • Student Health and Counseling Services
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  • Student Health & Counseling ServicesClose Left Navigation 麻豆传媒社区入口
  • Hours of Operation
  • PATIENT RIGHTS & RESPONSIBILITIES
  • Appointments
  • Immunization Requirements and Recommendations
  • After Hours & Emergency Care
  • Quick Links
  • About SHCS
    • Sustainability Practices
    • Media
    • Meet the Staff
    • Strategic Plan
    • National College Health Assessment Reports
    • FAQ
    • Feedback Request
    • Emergency Preparedness
    • Emergency Health Care
  • List of Services
    • ADHD Treatment
    • 锘緼辫辫辞颈苍迟尘别苍迟蝉
    • Counseling
    • Gender Affirming Care
    • Immunizations
    • Laboratory
    • Medical Abortion
    • Medication-Assisted Treatment
    • Men's Health
    • Mother's Room
    • Pharmacy
    • Pre-Exposure Prophylaxis (PrEP)
    • Psychiatry
    • Radiology
    • Sexual Health
    • Women's Health
  • Hayward Clinic
  • Concord Clinic
  • Counseling
    • Mission and Values
    • Counseling Options
      • Individual Counseling
      • Crisis Support
      • Group Counseling
      • Self-Help Videos
      • Counselor in Housing
      • Counselor in SEAS
      • Couples Counseling
    • Meet the Counseling Staff
    • Wellness Resources
      • Free Self Care Resources
      • Resources - Issues and Conditions
      • Resources - Communities
      • Political Stress
      • Avoiding Misinformation
      • Engaging Across Differences
      • Off Campus Counseling Referral List
      • Finding a Psychiatrist
      • Free and Low-Cost Psychiatry Referrals
      • On Campus Resources
      • Covid-19 Tips and Resources
      • Social Justice and Wellness
      • Pleasant Activities
      • Wellness Reading List
    • Other Related Information
      • Scope of Services
      • Eligibility
      • Client Rights
      • Client Satisfaction Survey
      • Faculty & Staff Resources
      • Wellness Ambassadors
      • Students in Distress
      • Presentation Videos
      • Self-Care After a Loss
      • Info for Parents & Family
      • Training Program
  • Forms
    • adhd-treatment-policy-revised-6-24-25.pdf
    • controlled-substance-agreement-revised-6-24-25.pdf
    • adhd-instructions-revised-6-24-25.pdf
    • authorization-to-disclose-mental-health-information-form-edited.pdf
    • authorization-to-disclose-mental-health-information-form-edited1.pdf
  • hipaa Privacy Practices
  • Other Related Information
    • Fee Schedule
    • Insurance

Forms

General
  • Request to Release Records
  • Authorization to Release Information
  • Authorization to Disclose Mental Health Information
  • Minor Consent Form
Feedback
Medical
  • Health History Form
  • Immunization Medical Exemption Request Form
  • Family PACT
  • Patient Complaint Form
Counseling
  • Safety planning resources:
    • Strength-Based Safety Plan (Adapted by Dr. David Emmert)
    • Personal Crisis Plan (Wellness Recovery Action Plan from )
    • SAGE Response to a Psychosocial Crisis (developed by )
    • Sample Advance Mental Health Directive

Psychiatry

  • Authorization to Disclose Mental Health Information
  • ADHD Treatment Policy
  • ADHD Medication and Controlled Substance Agreement
  • ADHD Treatment Instructions
  • Documentation of Previous ADHD Treatment
  • ADHD Assessment Process and Referrals
  • Guide to Finding a Psychiatrist in the Community
  • Free and Low-Cost Psychiatry Referrals 

If you have any questions, please call (510) 885-3735 or email shcs@csueastbay.edu.

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麻豆传媒社区入口, East Bay

25800 Carlos Bee Boulevard | Hayward, CA 94542 | 510-885-3000

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