The Counseling and Psychological Services at the Univerisity of Pennsylvania strictly protects the confidentiality of information shared during sessions. We are ethically committed to confidentiality and federal/state laws require it. This means that even your attendance in counseling is kept private and confidential.

State and Federal law states that there are four exceptions to this general rule:

  1. You may request (by means of a signed release) that your counselor reveal information to other individuals or agencies of your choice.
  2. In instances where there is imminent danger of serious harm to yourself or others.
  3. In cases involving physical and/or sexual abuse of children or endangered adults.
  4. Where otherwise requested by subpoena or mandated by court order or state/federal law.


In an effort to practice within the expertise of our licensed professions in the most ethical way, CAPS staff does not provide assessments regarding the need for emotional support animals. A staff clinician does have the discretion of providing a clinical summary, with the permission of the client, which will identify presenting symptoms and other clinical data that are within the scope of our practice. CAPS staff will provide this clinical summary only for active clients.


Click here for the Obtaining/Releasing Information Form.  This form is used for you to instruct us to talk to others about your care at CAPS.


CAPS will provide a record or summary to a third party, such as an insurance carrier, or to another treating professional providing mental health services. There is a process to help you with your request. It is important to note that in keeping with the ethical and legal standards of confidentiality, your written permission is necessary to share any information about your treatment at CAPS. Written permission includes a CAPS Release of Information form. (More below regarding this form)

Generally, CAPS issues a treatment summary or letter outlining services. If you are requesting an entire record, we would want to discuss this process with you. We consult as needed within the staff of Counseling and Psychological Services. If you are requesting completion of a third party company's form (insurance application, for example), we still need your signed CAPS Release of Information form.

Please follow the steps below:

Complete a CAPS Release of Information form and return it to CAPS one of the following ways:

  1. FAX: (215) 573-8966
  2. Email attachment: wallacek@upenn.edu
  3. USPS: CAPS 3624 Market Street, First Floor West, Philadelphia, PA  19104-2615

If you have a third party form to be completed, please complete your portion and send it to CAPS with your CAPS Release of Information form.


All requests to return from a leave of absence begin with your academic advisor.  After you make contact with your advisor, you may be directed to CAPS as part of the return from leave process. If you require our involvment in this process, please click the link below to download the checklist and required forms.
Return From Leave Paperwork