CHS Parents and Guardians - Student Referral to Mrs. Strong, PSW (Psychiatric Social Worker) Services
Please complete this form if you or your teen is in need of social support or mental health services. You will get a response within 2 school days from Mrs. Strong. If you are experiencing a psychiatric or health emergency, please call 911. If you are experiencing a mental health crisis and need immediate help, the Los Angeles County Department of Mental Health at 1-800-854-7771, or the National Suicide Prevention Hotline at 1-800-273-8255.
* Required
Name of Parent (Last name, First name)
*
Your answer
Email address
Your answer
Name of Student (Last name, First name)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Student Grade Level
*
Your answer
Current Home Address (# Street Name; City; Zip Code)
*
Your answer
Phone number (Enter as xxx-xxx-xxxx)
*
Your answer
Best Time to Call
*
8:00-10:00am
10:00am-12:00pm
12:00-2:00pm
2:00-4:00pm
Select from the following options:
*
I would like to talk to someone as soon as possible about my child and my concerns.
I would like to talk to someone within the next few days. about my child and my concerns.
Submit
Never submit passwords through Google Forms.
This form was created inside of LAUSD.
Report Abuse
Forms
