How would you rate your need to see a counselor today? If this is outside school hours, and your answer is "5" please contact an available adult immediately or call 911. This form is not manned 24/7 and is not a crisis line.
I'd like to see someone today but my issue isn't an emergency
I am concerned for the immediate well being of myself or someone else.
Clear selection
What period is best for us to call you down?
Choose
1st hour
2nd hour
3rd hour
4th hour
1st Lunch
2nd Lunch
5th hour
6th hour
7th hour
Fill us in: Please use this space to provide information to us that might be helpful in our time together.
Your answer
A copy of your responses will be emailed to the address you provided.