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WaHi Student Referral Form
Telebehavioral Health Services at The Health Center
Reach us by email at: WaHi@thehealthcenterww.org
Or by phone at: (509)562-8674
If you have an immediate safety concern, you need to call the crisis line: 509-524-2999 or 9-1-1
The Health Center will respond to this referral within one week.
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Email *
Name of Person Completing this Referral *
Relationship to student: *
Student's First Name *
Student's Last Name *
Student's Date of Birth *
MM
/
DD
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YYYY
What is the best phone number to reach the student (THC can call but cannot receive or send text messages)? *
What is the address where the student is sleeping? *
Current School *
Grade *
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