NMT Counseling Services:

Request for Services Form

一旦提交，您将收到一封电子邮件，说明您的预定日期和时间 appointment. 

远程医疗为高等教育提供了便利

行为健康咨询 • URGENT CARE 

The Counseling Center is very excited to announce that NMT has partnered up with the Virtual Care Group (VCG), to offer free 为我们的学位寻求提供补充医疗服务(每期3 - 5次) students. (在提示时使用87801邮政编码)

•                         扫描二维码开始吧!! 

If you have been seen before by the Counseling Center, please complete the returning clients form below. (除非是在本学年，那就发邮件吧 counseling@2ve6n74.net).  

请务必写上3个你有空的日期和时间. 

RETURNING CLIENTS FORM

Purpose: 本文件的目的是为学生提供关于未到校的指导 或延迟取消与咨询中心的预约.
Why: The Counseling Center is funded, in part, by student fees and there is an expectation 学生的学费应以负责任的方式处理. 当学生不来上课时 a scheduled appointment, valuable professional time goes without being used and other NMT学生无法及时获得服务.
How: 为了取消预约，学生需要打电话给咨询中心 575-835-6619或电邮至counseling@nmt.在预约的前一天下午3点前完成. A $25 No-Show Fee will be billed to the student account for any missed in-person or tele-therapy appointments 不能在前一天下午3点前取消.
Waivers: We understand that there are unforeseen circumstances that may prevent someone from providing
适当的取消通知. 如果你相信你有正当的理由 for missing an appointment without notification and would like consideration for waiving 此费用，在1周(5个工作日)内书面通知咨询中心。 of missed session. 每一次延迟取消或缺席豁免将被评估一个 每位学生只可获豁免一次. We reserve the right 拒绝为错过两次或两次以上咨询预约的学生提供服务 在学年期间，恕不另行通知. 被拒绝服务的学生 会否转介给本地/社区服务提供者，以满足他们的精神健康需要.

The first step is the initial needs assessment appointment where the clinician determines the nature and impact of the presenting concerns and to identify options for addressing these issues. 如果需要额外的治疗，临床医生会推荐 most effective method of treatment, which may include brief-solution focused treatment, group counseling, career exploration, Academic Advising/Student Success, Student Access Services, skills workshops, support from a peer supporter or referral to an off-campus mental health provider. 在某些情况下，评估预约是足够的 找出解决问题的方法.

Some of the concerns that are commonly addressed in short-term counseling at the Counseling Center are:

• Personal Concerns: 压力，焦虑，抑郁，愤怒，孤独，内疚，自卑，悲伤
• Relationship Concerns: 恋爱关系，室友问题，家庭问题，社交生活
• Developmental Concerns: 适应大学生活，选择健康的生活方式，做决定，生活的转变
• Academic Concerns: Performance anxiety, perfectionism, academic difficulties, low motivation, underachievement

学生的需求超出了服务或日程安排的范围 都可以参考社区资源. The Counseling Center 在初步需求评估后或根据这些因素提供转介服务 在服务过程中变得更加明显. 一些常见的问题 addressed through referral to services outside of the Counseling Center for longer-term 或者更深入的咨询包括:

• 渴望或需要每周见一次面，或渴望持续的长期心理治疗
• History of multiple hospitalizations; chronic suicidality and/or self-injurious behaviors; 有多次自杀企图的历史
• 有明显迹象表明需要更密集的服务
• 表明短期治疗可能有害或无益
•  精神或情感功能逐渐退化的证据或危险 这需要强化干预
• Exhibiting psychotic symptoms without willingness to follow treatment recommendations
• Inability or unwillingness to provide the necessary information to thoroughly assess symptoms
• Students who are already receiving ongoing therapy with another mental health provider
• Students seeking therapy for the sole purpose of obtaining documentation for another office (i.e. 欧空局信件，住宿生活)
• Client concerns that required open-ended, ongoing psychotherapy before coming to NMT

A need for specialized services not available through the Counseling Center, as indicated by:

• Presence of significant drug or alcohol problems such as substance dependence and/or past failed treatments; a need for drug testing
• 存在明显的、长期的和/或未经治疗的饮食失调 
• 要求药物治疗或药物管理
• 申请心理评估以获得就业许可 
• Request for services to fulfill clients’ court-mandated assessment or treatment requirements 

The general guidelines listed above are only intended to serve as a guide to assist treatment decisions. 由于提出关切、决策的性质和复杂性 regarding treatment recommendations and/or community referrals are made on an individual basis by clinicians in consultation with the clinical team of the Counseling Center.

• If you are in imminent danger to yourself or are a significant danger to someone else, 为了保护您和/或其他人，我们有法律义务打破保密.
• 如果你虐待儿童/脆弱的成年人或告知我们有关某人 那么，我们是否有法律责任向有关当局报告这件事. Such a report could potentially lead to disclosure of your being a client and require 关于涉嫌虐待的证词.
• If, as part of an employment process or security screening you sign a release of records 关于从我们这里收到的服务，我们会要求您在我们的表格上签字以确保 that you are freely and knowingly releasing a brief summary of your contact with us.
• 你的记录也可以被法院传唤.g. if you claimed emotional damages in a lawsuit).
• We also reserve the right to consult with the NMT Health Center and NMT Behavior Intervention (BIT)团队在专业合适的时候.

因为所有的健康记录都是严格保密的，包括
心理健康记录，必须提供书面请求
指定所需的信息和您希望它的位置
be sent. 所提供的表格必须邮寄或传真至:

The Counseling Center
New Mexico Tech
149 Fidel Building
801 Leroy Place
Socorro, NM 87801
Fax: 575-835-6001

信息发布(ROI)必须包括:

• Copy of a photo ID
• Your name and address
• 电话号码和电子邮件地址
• Banner #900
• 出席的日期(包括你何时离开，是否……
  not you graduated)
• Reason for Request
• Your signature

If you choose to continue treatment with a new mental health provider and you would 就像您发送给他们的信息一样，向我们发送ROI，我们会将您的记录发送给 你的新心理医生. 请至少预留两(2)周的时间来处理申请.

要下载我们的信息发布(ROI)，请点击 here.

Raising mental health awareness can help you to understand your symptoms, find professional treatment, and, perhaps most importantly, break the mental health stigma that leaves 那么多人在暗中受苦.

心理健康包括我们的情感、心理和社会健康. It affects 我们如何思考、感受和行动. 它还有助于决定我们如何处理压力 对别人，并做出选择. 心理健康在人生的每个阶段都很重要，从 从童年到青春期一直到成年.

EDUCATION

• 东北大学，波士顿，马萨诸塞州
  Master of Science, May 2004
  Counseling Psychology
• 东北大学，波士顿，马萨诸塞州
  理学硕士，1998年9月
  Criminal Justice
• 麻省大学，波士顿，马萨诸塞州
  Bachelor of Arts, May 1997
  Summa Cum Laude

牌照及证书

• State of NM - LPCC 
• Certified QPR Trainer