Counselor Contact Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

As we continue to work through this period of school closure, you may use this form to contact

If you are having a mental health emergency or experiencing suicidal ideation, please contact with 911 or the resources listed below.

Crisis Text Line:
www.crisistextline.org
Text “Home” to 741741

National Suicide Prevention Hotline: 1-800-273-8255
https://suicidepreventionlifeline.org

Bluebonnet Trails Community Services 24 Hour Crisis Line 1-800-841-1255
http://bbtrails.org

Integral Care 24 Hour Help Line 512-472-HELP (4357)
https://integralcare.org

Email *

Student Name

Student ID

I am a

Student

Parent

Concerned Friend

Teacher

Clear selection

Please indicate the counselor you are attempting to contact.

Claudia Ruiz

Lisa DeMoss

Clear selection

Preferred method to contact you.

Phone

Option 1

Clear selection

Option 1

Clear selection

Enter contact information below

I would like to discuss

Grades

Current Classes

5th to 6th grade transition

Concerned about a friend

My feelings (stress/anxiety, sadness, anger etc.)

Clear selection

Please enter your question or concern in the box below.

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Leanderisd.org. Report Abuse

Forms