Request To See a Counselor 2016-17
Thank you for visiting The Burke County High School Counseling Office! We are happy to help you but might not be available right now. Please fill out this form, and your counselor will call for you as soon as possible.
Confidentiality Disclaimer
All conversations are confidential with the following exceptions:
1. Someone wants to hurt you or is hurting you;
2. You want to hurt someone or you are hurting someone;
3. You want to hurt yourself or you are hurting yourself.
What is today's date? *
Your answer
What is the current time? *
Your answer
What is your first name? *
Your answer
What is your last name? *
Your answer
Which counselor would you like to see? *
What cohort are you in? *
What can we help you with? *
How would you rate your need to see a counselor today? *
If this is outside school hours, and your answer is "5" please contact an available adult immediately or call 911. This form is not manned 24/7 and is not a crisis line.
I'd like to see someone today, but my issue isn't an emergency.
I am concerned for the immediate well being of myself or someone else.
What period is best for us to call you down? *
Fill us in *
Please use this space to provide information to us that might be helpful in our time together.
Your answer
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