Baker Counseling Referral Form                    
Welcome to our online virtual counseling request form. This form is a communication tool for students, parents and staff to address any needs that may occur. Please fill out the form in it's entirety.  Your child's counselor will contact you as soon as possible to set up a meeting time.
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Email *
Please note: This form is for non-emergencies only. Threats of harm to self or others should be reported immediately to 911 as counselors and administrators are not available upon demand. If you have immediate concerns for a child’s safety and/or believe they are victims of abuse, please make a CPS report or call 911. The following numbers are available 24/7: The National Suicide Prevention Hotline 1-800-273-TALK. The Text Suicide Hotline: Text HOME to 741741 to connect with a crisis counselor. Community agencies: Bayview Behavioral Hospital 361-986-8200 and Nueces Center for Mental Health and Intellectual Disabilities 1-888-767-4493
Please indicate if you are a student, parent or teacher.  
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First & Last Name (of person filling out the form)
Student Name & (ID #, if you know it)
Please indicate student's grade level.
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Please indicate your preferred method of communication*
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Phone Number if you are a Synchronous Student or Parent
Please share what you would like to discuss *
If you choose "Other" please type your concern.  
How important is your need to speak to me? *
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Which day of the week is best to schedule a meeting?
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Time of day preferred
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The school counselor will make every effort to ensure a confidential conversation, and as always if your counselor is concerned you may harm yourself or others, or that someone is causing you significant harm, your counselor will notify the appropriate persons.
A copy of your responses will be emailed to the address you provided.
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