Forms

A Release of Information form will need to be filled out if you request your records for yourself, to be released to others or to speak to anyone about your appointments. Please download and fill out the form below and submit to our Dropbox.

Release of Information [PDF]

HOW TO SUBMIT DOCUMENTS

Save the completed forms as a PDF using your CSUDH ID# and the title Intake or Consent as the saved filed name (Ex. 12345678Intake and 12345678Consent).

Submit completed forms to the Student Psychological Services Dropbox located at https://www.dropbox.com/request/h6CUhhPSF5qP80YwWsAR, or click on the box below.

Please call 310.243.3818 after you have submitted your forms to the Dropbox.

How to E-Sign the Forms

Open the .pdf file from the Student Psychological Services webpage (please note that not all forms require a signature, but there will be areas that we need you to fill in).
Select Fill and Sign from the Right Navigation Panel and then select Fill & Sign from your options.
The fill-able form is displayed. Once you complete your form and are ready to sign; click on the icon that looks like an ink pen (at the top of the toolbar).
Add your signature by clicking Add Signature.
Type your name on the line; draw it or insert an image of your signature. Click on Save Signature (for later use for other forms) and then click Apply.
Once you click Apply, the signature is on the form where you can drag to the signature line. Don't forget to date your document.

Forms

Forms

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