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Schedule an Appointment w/ Ms. Biles
THIS FORM IS CONFIDENTIAL AND ONLY SEEN BY MS. BILES.
I am obligated to break confidentiality is if I have concerns about your safety or someone else's.
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Email
*
Your email
TTSD 6-digit Student ID Number
*
Your answer
Grade
*
6th Grade
7th Grade
8th Grade
9th Grade / Freshman
10th Grade / Sophomore
11th Grade / Junior
12th Grade / Senior
Required
Student Preferred Name
*
Your answer
Gender Preferences
*
Male (he/him)
Female (she/her)
Non-Binary (they/them)
Prefer not to say
Topic
*
Check In
Family Resources
Schedule / Forecasting
Future Planning / College
Urgent Suicide/Safety Concern for myself or another person
Peer Conflict / Bullying / Harassment / Incident
Other:
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