Loyola University Chicago

Wellness Center

Student OPTIONAL Disclosure of Private Mental Health Information

In compliance with the State of Illinois Student Optional Disclosure of Private Mental Health Act, all incoming students of Loyola University Chicago have the opportunity to identify any adult individual/s that you would wish to be notified in the event that a qualified mental health provider employed by the University refers you for inpatient psychiatric hospital care if it is determined you might pose a danger to yourself or to others.

Completion and submission of this form is completely optional. If you do not wish to designate such a contact person, there is nothing more you need to do. If you do wish to designate such a contact person, or to revise or withdraw a previous selection, please complete this online form.

If you have any questions please call the Wellness Center at 773.508.2530.