Counseling Center Appointment
This form was created in order for the Counseling Center to be more developmentally responsive to the students of South Orange Middle School.  The request will be forwarded to your counselor who will work to make an appointment with you during school hours only.  If you need immediate help during non-school hours please see the following information.

Mental Health Hotline - 866-202-4357 https://www.njmentalhealthcares.org/
Suicide Prevention Hotline - 1-800-273-8255
Response On-line Hear2Help - www.responsehotline.org
Crisis Text Line - https://www.crisistextline.org/
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First Name *
Last Name *
My Child's Grade *
I would like an appointment with my child's counselor *
Preferred method of communication *
Reasons for Appointment Request
Please check the box or boxes in the certain section that best applies to what you would like to discuss with your counselor.
Academic Concern
Academic & Career Planning
Personal Concerns
How would you rate your need to see a counselor today?   *
If this is outside school hours, and your answer is a "5" please contact an adult immediately or reach one of the above hotlines.
I'd like to talk to someone today but my issue isn't an emergency
I am concerned for the immediate well being of my child or someone else
Fill us in:  
 Please use this space to provide some detailed information to us that might be helpful in our time together.  This will remain confidential unless you feel you may harm yourself or someone else, or you know someone wants to harm themselves or others; in that case it is best for us to seek additional help for everyone's safety.
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This form was created inside of South Orange Maplewood School District.

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