Wellness Counseling Request Form
Hello from your Wellness Team, Ms. R and Ms. L! We are excited to serve the ECHS community. We are here to help students who need extra support in any social-emotional capacity.

Some examples of supports provided are:
-General emotional support
-Stress management   
-Anxiety/Depression symptoms                  
-Grief/Loss       
-Interpersonal difficulties                              
-Community resources and finding a therapist    
     
Students: Are you going through a challenging time and need someone to talk to? Are you concerned about a friend who may need additional support?

Parents/Guardians and Staff: Have you noticed some behaviors and are not sure if you should be concerned? We can support you in supporting your student through this difficult time.
_______________________________________________

You can request an appointment by filling out this form. We are available and see responses during school hours, 8:30am-3:20pm. You can expect an appointment within one week of submitting this request.

If this is an emergency please leave this form and dial 911 or visit your nearest hospital emergency room, if you can get there safely.

If you have reached this form after school hours and would like to speak with someone at this time, some resources are listed below:

Suicide Prevention Hotline: 1-800-273-8255 or 9-8-8
Crisis Text Line: text HOME to 741-741
StarVista 24/7 Crisis Hotline: 650-579-0350
Starvista Text Line (Mon-Thurs 4:30-9:30pm): 650-747-6463
Trevor Project (LGBTQ+): 1-866-488-7386 or text START to 678-678
Non-Emergency 24/7 Warm Line: 1-855-845-7415
Rape Trauma Services 24/7 English & Spanish Crisis Line: : 650-692-7273

*Please note that all responses to this form are confidential and will only be viewed by the ECHS Wellness Team unless it is stated that a student is being harmed by someone else, a student wants to harm others, a student wants to harm themselves, or a student gives us permission to share with a trusted adult.

We will do our best to meet with you as soon as possible; however, your preferred time may not always be feasible. Thank you for your understanding and patience.

With care, 
Ms. R and Ms. L
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