Complete this form to refer a student to site-based therapeutic services. Site-based Licensed Mental Health Professionals cannot work with students who are already receiving therapeutic services in the community.
This form is not intended to make a referral for crisis situations.
*If you have concerns that a student is at risk of harming themselves or others call the Oklahoma Crisis Line at 988 or 911.
*If you believe that a student is being abused make a referral to DHS at 1-800-522-3511.
*If you need immediate crisis assistance call the Mobile Crisis Response Unit at 1-833-885-2273.
The responses to the following questions will be seen by program staff and will be used to determine eligibility for services.
