NormanAid Wellness Center Appointment Request
This form is for BHHS and BVMS (including ILC) students, parents and staff to request or recommend counseling services. The NormanAid Counseling Wellness team provides weekly, short term, group and family counseling services.
The NormanAid Wellness Team includes BHHS Wellness Counselor Ali Norman-Franks, Maple Center Counselors and counseling interns from USC and LMU.
Virtual counseling is available Monday-Friday from 8:00 am-6:00 pm.
We will respond to your request as quickly as possible. For additional resources, visit
normanaid.org
.
*IF YOU HAVE AN EMERGENCY AND NEED IMMEDIATE HELP, PLEASE CALL 9-1-1 or GO TO THE NEAREST EMERGENCY HOSPITAL
* Required
Students last initial (Don't include full last name)
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Your answer
Student's first name (Don't include last name)
*
Your answer
Student ID (long or short)
Your answer
Students, please provide your BHUSD email AND your personal email so we can contact you and schedule your appointment. Please check your junk mail.
*
Your answer
Students Cell Phone Number (You can write "none" if need)
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Your answer
Request being made by
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Student
Parent/guardian
BHUSD Staff Member
Name of Person Making the Request
*
Your answer
School of Attendance
*
BHHS
BVMS
ILC
Grade
*
6th
7th
8th
9th
10th
11th
12th
Age of Student
*
Your answer
Email of the person referring student to NAWC (Parent's/Staff Member)
Your answer
Is there any information you would like to share with the Wellness Counselor before the meeting? If so, please share below.
Your answer
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