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Referral to Mrs. Wilson-Thompson/Mrs. Panion
To make a referral or request an appointment with a counselor, please fill out the information below. If this is an emergency (suicidal thoughts or actions, fear of harm by self/others, etc.) please go to the counselor or other trusted adult immediately. If this is an emergency outside of school hours, call 911.
I am *
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Student's Last Name *
Your answer
Student's First Name *
Your answer
Name of Referring Person (if not self)
Your answer
Your Contact Email
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Your Phone
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Best time to contact you to make an appointment
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Priority *
Reason for appointment *
Please check all that apply
Required
Please briefly explain if you can:
"I'm struggling with homework", "fight with friend", "scholarship questions"....
Your answer
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