TNS Mental Health Community Referral Request
DO NOT FILL OUT THIS FORM IF you are experiencing a medical or mental health emergency. Instead, please go to your nearest hospital emergency room or in the U.S. call 911. 

For crisis assistance, call, dial or text 988 (988 Suicide and Crisis Lifeline)  or visit NYC Well at https://nycwell.cityofnewyork.us/en/

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***Important Reminder***
If you are receiving medical or mental health care, it is important that you work with your current provider(s) to ensure your continuity of care. Upon moving to New York City, we recommend you bring with you the following: 
  • Your current Health Insurance Card (Please verify if it will provide coverage for you in NYC)
  • A 90 day supply of your prescription meds (this gives you time to find a local provider when you arrive in NYC)
  • A copy of your psychiatry or neuropsychological evaluation, if applicable
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***About New School Student Health Services (SHS)***
1) SHS does not offer long-term services. All services we render are short-term. For counseling, students have access to free individual counseling up to 10 sessions per academic year. In addition, services such as support groups, mindfulness sessions, and ear acupressure are available. 

2) If you are seeking care for previously diagnosed mental health conditions and are not interested in counseling services at SHS, please fill out this form or schedule a brief assessment to address your needs. 

3)Our clinic does not offer standalone psychiatry/psychopharmacological services such as medication refills. Psychiatry services are only available to students in short-term counseling at SHS. 
SHS does not offer comprehensive neuropsychological testing. We can assist you in finding community referrals for this service. 

4) For students in counseling at SHS seeking to continue medication treatment for previously diagnosed ADHD, we require the following documentation:
  • comprehensive neuropsychological testing report
OR
  • (if diagnosed in childhood) comprehensive psychiatric evaluation report- clinical interview and observation including a detailed description of persistent impairment in 2 or more settings, a full developmental history, educational history, third party reports (caretaker / teacher), and rule-out of other possible causes for impairment
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Name (First and Last) *
Your phone number (digits only) *
Your email address *** If you are a TNS student, please enter your school email address *
Your relationship with the New School Student *
New School Student Name (First and Last) *
New School ID Number
Age Range of the Student *
Student's Primary State Residence during academic year 2022-2023 *
Student's Insurance Plan while the student is attending the New School ***We are the most familiar with the listed carriers below. We also refer you to providers according to your budget. Please note that Medicaid and State Affordable Care Act Insurance do not have out-of-state coverage. *
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