SFHS Counseling: STUDENT Request

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Thank you for checking in! Please complete this school counseling request form to request that Brandy can contact you. Your referral will be handled within 48 hours via email, phone, or zoom.

Note: Below are resources available should you find yourself or someone else in a situation where immediate mental health services are needed. If this is an emergency, call 911.

National Suicide Prevention Hotline --- 1.800.273.8255
Central Crisis & Suicide Prevention Hotline --- 1.888.506.5991
Crisis Text Line --- Text HOME to 741741

Please understand that confidentiality cannot be guaranteed in virtual meetings. The School counselor will make every effort to ensure a confidential conversation, and as always, if there is a concern that you may harm yourself or others, or that someone is causing you significant harm the appropriate persons will be contacted.

Email *

First Name *

Last Name *

Grade *

9th

10th

11th

12th

How are you feeling today?

I feel great

I feel okay

I don't feel that well

Other:

Clear selection

Reason for Request *

Academic

Social-Emotional or Personal or Home Environment

Career/College Readiness

Other:

Briefly State Reason for Request *

I would like to talk to someone *

Sometime this week

Within the next 2 days

As soon as possible

Please contact me *

by student email

by phone

by zoom

Please provide best email/phone number: *

Send me a copy of my responses.

Submit

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