Rancho Pico Wellness Appointment Request

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Rancho Pico Wellness Appointment Request

Welcome to Rancho Pico's Wellness Center Request Form.

Thank you for reaching out for support!

If you are stressed, overwhelmed, concerned and/or dealing with something personal, we are here for you. Please reach out and schedule a private appointment by completing this form. You will be contacted as soon as possible, please note this is not an immediate service, and requests are checked throughout the week. If this is an emergency, please contact 911 immediately.

Schedule an appointment here or feel free to stop by the Center during school days during brunch or lunch.
When we receive your request we will send out a summon. We are here to help!

If you know someone who needs immediate help, please call the National Suicide Prevention Lifeline at 988 or 800-273-TALK (8255) or contact the Crisis Text Line by texting HOME to 741741.

Be Well

Email *

Name *

Student ID # *

Grade *

I hereby certify that I am 12 years of age or older and I am the individual stated above to seek out mental health support services from Mrs. Mathers at my school wellness center and/or school social worker's office

I am the parent of the student

Required

Briefly describe how we can help *

Submit

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