Wellness Appointment Request
Fill this form out if you would like to make an appointment with a Wellness Counselor. We will get back to you within 24-48 hours. If you would like to make an appointment with your School Counselor, please contact them directly.

We will reach out to you by email or phone call.  Please note: we will be discrete, but cannot guarantee confidentiality over email or via technology!

If you have an emergency or crisis please call 911 or go to www.tamdistrict.org/Page/8814 for crisis support phone numbers/text lines.
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Email *
What is your first and last name? *
Would you prefer to talk to a Wellness counselor or a Peer Resource student? *
What grade are you in? *
What is today's date? *
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Is this an appointment for you or for a friend? *
If referring for a friend, what is your friend's name?
If referring for a friend, have you talked with them about your concerns, or let them know that you're referring them?
What do you (or your friend) need support with (for example: anxiety, family stress, relationships, etc)? *
What is the best way to contact you to set up an appointment? *
What is your phone number? Only fill out if you are okay with receiving a phone call.
Generally, we would like to get parent permission for you to talk to someone in Wellness for support.  Are you comfortable with this? *
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