Share a Concern

We have limited capacity to provide feedback or follow up with you if you remain anonymous.

Please be sure to include as much information as you can about your experience and your desired outcome. If possible details of dates/times of incidents or screen shots of interactions.

This form is collecting information for the purpose of the services that we provide within the Careers and Employability; Social Justice, Equity and Inclusion; and Health and Wellness teams. The quality of our services relate to a best-practice model of multidisciplinary teamwork whereby staff within the service may consult with one another to discuss various aspects of your support. All staff of the service will have access to your personal information (which may include appointment and/or clinical notes) and student records. Your health, psychological and safety concern records are stored separately and are only accessible by authorised staff members. Staff will only access your personal information, health records and/or appointment notes when it is required as part of an assessment, diagnosis (if necessary) and intervention of your presenting issue. We are committed to protecting your privacy and this form ensures that you understand the conditions of our Service.

Our service will opt to communicate with you via email, SMS, or phone unless you advise us otherwise.

For a full understanding of our privacy information and management of your personal information, please access the Service Privacy Statement located in our waiting rooms or at https://www.usq.edu.au/current-students/support/counselling, in addition to the USQ Privacy Statement located at https://www.usq.edu.au/about-usq/governance-leadership/corporate-responsibility/privacy/privacy-statement.

Please Note: If, after reading this you are at all unsure of what is written, please discuss it with the staff member you are seeing for services. Failure to consent to these conditions may result in our inability to provide a service to you.

I confirm that I have read and understood the above principles in conjunction with the Privacy Statement. I agree to these conditions for the services provided by the Careers and Employability; Social Justice, Equity and Inclusion; and Health and Wellness teams.

This form is collecting information for the purpose of the services that we provide within the Careers and Employability; Social Justice, Equity and Inclusion; and Health and Wellness teams. The quality of our services relate to a best-practice model of multidisciplinary teamwork whereby staff within the service may consult with one another to discuss various aspects of your support. All staff of the service will have access to your personal information (which may include appointment and/or clinical notes) and student records. Your health, psychological and safety concern records are stored separately and are only accessible by authorised staff members. Staff will only access your personal information, health records and/or appointment notes when it is required as part of an assessment, diagnosis (if necessary) and intervention of your presenting issue. We are committed to protecting your privacy and this form ensures that you understand the conditions of our Service.

Our service will opt to communicate with you via email, SMS, or phone unless you advise us otherwise.

For a full understanding of our privacy information and management of your personal information, please access the Service Privacy Statement located in our waiting rooms or at https://www.usq.edu.au/current-students/support/counselling, in addition to the USQ Privacy Statement located at https://www.usq.edu.au/about-usq/governance-leadership/corporate-responsibility/privacy/privacy-statement.

Please Note: If, after reading this you are at all unsure of what is written, please discuss it with the staff member you are seeing for services. Failure to consent to these conditions may result in our inability to provide a service to you.

I confirm that I have read and understood the above principles in conjunction with the Privacy Statement. I agree to these conditions for the services provided by the Careers and Employability; Social Justice, Equity and Inclusion; and Health and Wellness teams.