HBMS School Counselor Referral Form
Please use this form to request to meet with Ms. Chang or Ms. Hudson 

PLEASE NOTE: This form is only monitored during school hours only. If you are experiencing a crisis or if this is an emergency, please call 911,  or contact a crisis hotline: 
  • Fulton County Department of Mental Health Hotline 404-730-1600
  • Georgia Crisis & Access Line ∙ 1-800-715-4225
  • National Crisis Line ∙ 1-800-273-TALK (1-800-273-8255)
  • Suicide Prevention Hotline ∙ 1-800-SUICIDE (1-800-784-2433)
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I Am A... *
Date *
Student Name (First and Last) *
Grade *
Homeroom Teacher  *
Best Email To Reach You:
What is The Nature Of Your Concern (Check All That Apply) *
Briefly Describe Your Concern (If the matter is private or reporting suspected abuse, type "PRIVATE") *
The Concern Is.... *
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