CONSENT for School Medical Care & Counseling Support

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Please complete a form for each child for consent for medical and counseling support.

Consent for Medical Treatment and Counseling/Mental Health Support Services

Non-Emergency & Emergency Medical Care Treatment - Nurses & Employee Support

In accordance with the recently passed "Families’ Rights and Responsibilities Act," Public Chapter No. 1061, minor students cannot receive medical care without the consent of a parent/legal guardian. This includes, but is not limited to, cleaning and bandaging minor cuts/abrasions, providing an ice pack, and/or managing injuries. If a parent/legal guardian does NOT provide consent to treat, the school nurse and/or any other school employee can only treat the student in the case of an emergency.

Counseling Services – School Counselors (previously referred to as Guidance Counselors) and Frontier Health School-Based Liaison and Case Managers

According to Tennessee's Public Chapter 1061, parents or legal guardians require written permission for their minor children to receive counseling services from either a school counselor or a contracted service provider, such as Frontier Health. If a parent/legal guardian does NOT provide consent for counseling services, a school counselor or a contracted service provider can only provide services in the case of a mental health crisis/emergency. Permission is not required for students to see school counselors for academic planning purposes or in situations such as resolving interpersonal conflicts between students.

School counselors and contracted mental health service support on campus (Frontier Health School-Based Liaisons, Frontier Health School-Based Case Managers, Communities in Schools Student Support Coordinators, and other contracted services housed in our schools) aim to support the mental and emotional well-being of students:

Individual and group counseling for emotional and behavioral issues
Support for students dealing with trauma or significant life changes
Substance abuse counseling and prevention programs
Support for anxiety, depression, and other mental health conditions
Coordination with external mental health providers

Email *

Student First Name *

Student Middle Name *

Student Last Name *

Select the school your child attends: *

Select the grade level of your child: *

CHECK ALL that apply to give CONSENT for the following (if you check "Neither of the Above" your child will not receive medical or mental health services): *

Medical care for my student (other than non-emergency first aid)

Contracted Mental Health Support/Services on Campus

Neither of the above (Your child will NOT receive non-emergency medical care or mental health support services)

Required

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Phone Number *

Type your first and last name to enter your electronic signature. *

Send me a copy of my responses.

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