Request for counselling services

The service will be closed on Wellington Anniversary Day Monday 25th January and Waitangi Day Holiday Monday 8th February. Form submissions will not be responded to on these dates.

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

Contacts for after-hours assistance or if you're at risk

  • Crisis Team: 0800 800 717
  • Lifeline: (09) 5222 999 or 0800 543 354
  • Youthline: 0800 376 633 or free txt 234
  • Anxiety New Zealand: 0800 ANXIETY or 0800 269 4389
  • Depression helpline: 0800 111757
  • Text or phone 1737 anytime for counselling assistance

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:
Citizenship:
Number of papers you are taking this semester:
Ethnicity:
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 contact@massey.ac.nz Web chat Staff Alumni News Māori @ Massey