Houston High School Counseling Request Form for Mrs. Sobotta
Please use this form to request a phone, virtual or in person appointment with Mrs. Sobotta. I will do my best to accommodate your request, or email you with an alternate time. You will receive an email at your HSD email or parent email listed in Campus with instructions for your appointment. Please reply to that email ASAP if you have questions or think you may need help joining a virtual counseling session.

*Required
Using technology to discuss personal and private matters does not ensure the same level of confidentiality as face to face encounters. I recognize that there are limitations and risks with online communication. Please review the "Virtual Counseling Informed Consent form" on Mrs. Sobotta's webpage for more information.
Clear selection
*Important Information*
This form is for non-emergencies only. Threats to self or others should always be reported immediately to the counselor or an administrator. If you have immediate concerns for a child's safety and/or believe they are victims of abuse, please make a Child Protection report or call 911.
Please understand that confidentiality cannot be guaranteed in virtual meetings. Mrs. Sobotta will make every effort to ensure a confidential conversation, and as always if she is concerned you may harm yourself or others, or that someone is causing you significant harm, she will notify the appropriate persons.
Email Address*
Student first name* *
Student last name* *
Grade level* *
Reason for needing to visit with Mrs. Sobotta *
The person completing this form is...* *
If you are a parent or a teacher/staff, what is your first and last name?
What type of appointment would you like? *
Please list your preferred dates/times that you would like an appointment. You will receive an email confirmation with your scheduled appointment time. Mrs. Sobotta will email you a confirmation of your scheduled appointment.
Submit
Never submit passwords through Google Forms.
This form was created inside of Houston School District #294. Report Abuse