St Joseph's School Counselling

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CONFIDENTIAL REFERRAL FORM:

- Once this form has been completed, you will be contacted to sign one further consent form.

- You will be advised whether the Counsellor can start seeing your child straight away, or if there is a wait-list.

- The Counsellor is onsite 1-2 days per week. The time she sees your child may vary each week depending on the length of session, absences etc. Exact appointment times cannot be requested.

- You will be advised once your child starts their sessions with the Counsellor, and when the Counsellor and student agree that they have made enough progress to cease sessions (even temporarily for a break), you will also be advised at that point.

Date of Referral *

YYYY

Time

Name of Referral *

Date of Birth *

YYYY

Referral Age *

Gender *

Boy

Girl

Prefer not to say

Ethnicity *

Room Number/Name *

Teacher *

Teachers Email *

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