School Counselor Referral Form
Use this form to request a meeting or refer a student to individual counseling. Please only complete for ONE student at a time. Contact Ms. Mackenzie if you have any questions!

Individual Counseling Information and Disclaimer:
Individual sessions are based on theories of solution-focused counseling meaning that we problem solve within a few sessions maximum, and continue brief check-ins throughout the year depending on the need.  Please be aware, my focus as a School Counselor is on the entire school, so I try to see as many students as possible, (in other words, I have 220+ clients!!). Therefore, I am unable to provide long-term clinical counseling services to students. I am happy to provide you with a list of referrals in the community for the care that your student needs if you are seeking intensive, long-term services. I often collaborate with these professionals for further school based needs. I am always open to learning about your student's specific social and emotional needs and provide them with whatever I am able to here at school.
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Email *
I am a *
Your Name  *
Name of student you are referring *
What is the reason for your referral? Please provide as much information as you feel comfortable sharing.
Any additional details you'd like to share
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