Harlandale Care Center Request for Services

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To request counseling services, please select from the menu below. If requesting services for a student, this form must be filled out by the parent/legal guardian.

Para solicitar servicios de consejería, por favor seleccione una opción del menú a continuación. Si solicita servicios para un estudiante, este formulario debe ser completado por el padre, madre o tutor legal.

Select from the options below / Seleccione una de las siguientes opciones *

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