Logan High School Social Worker/Psychology Request Form

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LHS social work intern and school psychology intern clinical therapy services are available through individual and group sessions.

Participation in this service requires a parent or guardian signed release upon completing this form.

Email *

Record my email address with my response

Parent name: *

Student name: *

Student Grade: *

9th Grade

10th Grade

11th Grade

12th Grade

Phone number:

Parent email address:

Would you prefer individual or group therapy services? *

Individual

Group

Not sure (would like more information)

Required

Brief description of reason for being referred: *

Is the student receiving outside counseling/therapy services? *

Yes

I don't know

Submit

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