Counseling Request Form
The School District of DeSoto County is offering virtual counseling opportunities for students during school closures. To request that a Social Worker/Mental Health Counselor contact you to discuss counseling for your child, please complete the form below. This form is for NON-EMERGENCY USE ONLY.
Please note: If you are requesting services for multiple children, a separate form must be completed for each child.
What is your relationship to the child:
Parent or Guardian
Other (if selected please answer the question below)
If "Other" was selected to the question above, please provide more information about your relationship to the child.
Please select your child's school:
DeSoto High School
DeSoto Middle School
DeSoto Secondary School
Memorial Elementary School
Nocatee Elementary School
West Elementary School
Child's Date of Birth (mm/dd/yy)
Is the child currently receiving counseling services?
If you answered yes to the above question, please specify the provider below.
Contact information: Please provide one or more contact numbers below.
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This form was created inside of School District of Desoto County.