LMS Wellness Center Visit Form

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LMS Wellness Center Visit Form

Welcome! Fill out this form if you would like to visit the Wellness Center. 

The Wellness Center is a quiet, calm, and safe space where you can access a variety of support and resources. When you're here you get some time to yourself to re-center your thoughts and emotions so that you can carry on with the rest of your day.

1.) Fill out this form prior to coming to the Wellness Center 

2.) Once submitted, we will call you into the Wellness Center as soon as possible

*THIS FORM IS NOT FOR CRISIS SITUATIONS*
If you are in a crisis, please visit the Wellness Center, or Counseling Office immediately to access support.
Additional Resources:
Crisis Text Line: text "home" to 741-741
National Suicide Prevention Hotline: 1-800-273-8255
Suicide and Crisis Lifeline: text or call 988
Trevor Lifeline LGBTQQ+ Crisis Support: 1-866-488-7386 or text "start" to 678-678
Call 911 and request a C.I.T. (crisis intervention team) trained officer to assist you


Please note: The information that you provide through this form will only be accessed by the Wellness Center and will remain private with the exception of: you harming yourself, harming others, or if someone is harming you.

Email *

First & Last Name *

Students ID Number

Grade *

7th

8th

Please explain your reason for visiting the Wellness Center (ex. conflict, anxiety, stress, overwhelmed, academic support, etc.)
*

We are so glad you reached out for support! We will be in touch with you to schedule an appointment as soon as possible. ****If you are experiencing a crisis, please visit the Wellness Center or Counseling office immediately.

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