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WaHi Student Mental Health Referral Form
Reach us by email at:
WaHi@thehealthcenterww.org
Or by phone at: (509)526-8674
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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* Indicates required question
Email
*
Your email
Name of Person Completing this Referral
*
Your answer
Relationship to student:
*
Self
Parent/Guardian
Academic Counselor
Other:
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Student's Date of Birth
*
MM
/
DD
/
YYYY
What is the best phone number to reach the student (THC can call but cannot receive or send text messages)?
*
Your answer
Current School
*
Your answer
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