Ms. Lindsey, District Mental Health Counselor Referral Form
Whether you are a student, caregiver, or teacher, you can fill out this form and I will reach out to you.
This form is confidential.


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Email *
If you or the student you are referring is in danger or it is an emergency, please call 9-1-1!
Responses will be monitored between the hours of 8:00am-3:30pm Monday-Friday
today's date : *
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Student Name:   *
name of person making the referral *
school *
grade *
teacher *
reason for referral *
How urgent is it? *
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