Spring Hill Social Worker Referral Form
Thank you for reaching out to your school social worker. Please be aware that I do not check email except during school hours. If this is a crisis or emergency call 911 or go to your local emergency room.

Confidentiality: Information students share with the school social worker is confidential. The student’s right to privacy is guarded as much as permitted by law, ethics, and school policy. The school social worker is obligated to break confidentiality when there is potential harm to the student or others, concern of neglect or abuse, or a court of law that requires testimony or student records.

At times, the social worker and school-based staff (teacher, counselor, principal, etc.) will need to exchange information about your child (how are they coping in class, strategies to help, etc.) All communication will take place only on a need-to-know basis.

E-mail transmissions may contain confidential health information that is privileged and legally protected from disclosure by the Health Insurance Portability and Accountability Act (HIPAA). This information is intended only for the use of the individual or entity named in the email. If you are not the intended recipient, you are hereby notified that reading, disseminating, disclosing, distributing, copying, acting upon or otherwise using the information contained in this e-mail is strictly prohibited.
Name of person making referral *
Relationship to student *
Name of student being referred *
Reason for referral (check all that apply) *
Required
If any of the above is checked, please briefly describe reason for referral:
Concerns About Safety / Abuse
Concerns About Safety / Abuse
If you are worried about your child or a child you know that is in immediate danger to themselves or others call 9-11 or take them to the emergency room immediately. If you are worried about the safety or possible abuse of a child contact DCS 877-237-0004 (https://www.tn.gov/dcs/program-areas/child-safety/reporting/child-abuse.html) immediately.
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