Mental Health Screening Request Form
The School District of DeSoto County has expanded our mental health services in the 2020-2021 to not only meet the needs of our students attending our brick and mortar schools, but also to students that are participating in school via DeSoto Online or My District Virtual School. If you are interested in having your child receive a Mental Health Screening, please complete the following form. This form is for NON-EMERGENCY USE ONLY.

Please note: If you are requesting services for multiple children, a separate form must be completed for each child.
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Email *
Parent/Guardian Name: *
Please provide one or more contact numbers below. *
Child's Name: *
What is your relationship to the child: *
If "Other" was selected to the question above, please provide more information about your relationship to the child.
Please select your child's school:
Clear selection
Child's Date of Birth (mm/dd/yy) *
Child's Grade:
If you answered yes to the above question, please specify the provider below.
Is the child currently receiving counseling services? *
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