Request a REMOTE visit with the Cox ES Counselor, Mrs. Hardy
If this is an EMERGENCY, please call 911 or your medical provider. Do not submit this form!

Things to remember when requesting an appointment:

*Parents must have read the Zoom/Phone Communication Agreement and Terms. https://drive.google.com/file/d/1tje1tit-RQ7gwEOjHvITebfW11zQdjlS/view?usp=sharing
*A parent phone number and email address must be included in the request.
*Emails and calls will be returned on school days and during regular school hours.
*If this is an EMERGENCY, please call 911 or your medical provider. Do not submit a form or email!
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Email *
Parent's Full Name and Today's Date: *
Parent Phone Number *
By checking yes and writing my name below, I agree that I am the legal guardian of the student I am requesting a remote visit for, and I have read and understand the Zoom/Phone Communication Agreement and Terms. Click on Link to Read: https://drive.google.com/file/d/1tje1tit-RQ7gwEOjHvITebfW11zQdjlS/view?usp=sharing  *
Required
If requesting a phone call or video conference (Zoom), what is the best time of day to call or Zoom?  *Office hours are 8-4, Mon-Fri. *
Person making the request for a remote visit *
Student's First and Last Name *
Student's Grade *
Request related to: *
Briefly describe the reason you would like to see the counselor. This allows me to look into your concern before we meet or to quickly email an answer to your question or concern, if appropriate. *
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