Request for counselling services

This assessment form is for students at Massey’s Wellington campus and all distance students residing in New Zealand.

Online assessment form - Wellington

Please complete this form before your first student counselling session.

About You
First name:
Last name:
Date of birth
(dd / mm / yyyy)
Massey Student ID
(numeric only)
Semester Address:
Home Address (if different from above):
Mobile phone number:
Home phone number:
Email address:
Preferred method of contact (you can choose more than one):

How would you best describe your gender?

Course of Study:
e.g. BA, BSc

The Degree you are studying for

Please tick the categories that apply to you

Current year of tertiary study:
Number of papers you are taking this semester:
If Other Ethnicity, please specify:
Attending Appointments

Please indicate when you can attend appointments - please choose more than one. The counselling hours are 8.00am to 4.00pm.

Are you interested in the option of group counselling?
(Groups are confidential, counsellor-led, therapeutic offerings for students on things such as anxiety, academic stress, relationships, and alcohol/drug use.)

Other information

Is there anything else you would like us to know?

Privacy Policy

Privacy Policy and Terms of Service:

I am aware that my response to this questionnaire will become part of my individual confidential record of contact with the Student Counselling Service. All data is collected and maintained according to the Privacy Act 1993.  Under the act students are able to apply to access or have copies of information held about them. We may share information with other health professionals such your doctor, ideally with your permission.

Email Address

Contact us Mon - Fri 8:30am to 4:30pm 0800 MASSEY (+64 6 350 5701) TXT 5222 Web chat Staff Alumni News Māori @ Massey