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LHS Self-Referral for School Social Work Services
If you would like to speak with Ms. Davis please complete this google form.
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* Indicates required question
Email
*
Your email
Name (first and last)
*
Your answer
Grade
*
Freshman
Sophomore
Junior
Senior
Is this an urgent concern?
*
Yes
No
Are you concerned for another student or yourself? (depression, talk of suicide, another student being bullied, abuse at home, etc.)
*
Yes
No
If YES, provide the name of the student(s) and the concern.
Your answer
If NO, why would you like to meet with Ms. Davis?
*
Conflict with Friend(s)
Death in Family
Divorce
I need a minute to Chill Out
Problem(s) at Home
Anxiety
Depression, but NOT Urgent
Just need to Talk
Grades
Other:
Best TIME to meet?
*
Your answer
Best DAY to meet?
*
Monday
Tuesday
Wednesday
Thursday
Friday
What is the best way to contact you? (email, phone, zoom, etc) Please provide that information so that Ms. Davis may contact you.
*
Your answer
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