Wellness Team Appointment Request Form
Thank you for reaching out to meet with someone from the Westmoor Wellness Team - our Wellness Counselors and School Social Worker. We are here to support you!

Wellness Counselors and School Social Worker can provide support with short-term mental health, stress management/mindfulness, grief/loss, anxiety/depression, health appointments, crisis, referrals to community resources/outside counseling, and more! No question or concern is too small!

You can request an appointment by filling out this form. We are available during school hours, Monday through Friday, 8:30am-3:30pm.  Requests submitted during nonscheduled school days or outside of school hours will not be checked until the next school day.

In case of an emergency please contact:
During school hours: Wellness Staff or an Administrator
Outside of school hours: Call 9-1-1 or go to your nearest emergency room

Other resources if you have reached this page after school hours are:
StarVista 24/7 Crisis Intervention and Suicide Prevention Hotline: (650) 579-0350
Suicide Prevention Hotline: 1-800-273-8255 or call 988
Trevor Project (LGBTQ+): 1-866-488-7386 or text START to 678-678

*Please note that all responses to this form are confidential and will only be viewed by the WHS Wellness Team unless it is stated that a student is being harmed by someone else, a student wants to harm others, a student wants to harm themselves or a student gives us permission to share with a trusted adult.

We will do our best to meet with you as soon as possible; however, your preferred time may not always be feasible. Thanks for your understanding and patience.

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With care, the WHS Wellness Team,                                                                                                         Ms. Phrani, Mr. Fung, and Ms. English
Student Full Name (First and Last Name): *
Class Level *
Relationship to Student/Family *
From 1 to 6 please indicate the urgency for us to meet with you. *
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Is there a period you prefer to not be called from?
Do you or your family need support with resources at this time (housing, food, clothing, etc)?
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If you answered yes to the previous question, name the supports you or your family need.
Briefly describe the need to see a Wellness Counselor or Social Worker. Examples include, grief/loss, depression/anxiety, or needing an appointment at DCYHC. *
Who would you prefer to meet with? *
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