School-Based Mental Health Online Referral
This form serves as a referral for school-based mental health services for students that attend the Albany, Juda, Blackhawk, Brodhead, or New Glarus School Districts. If your student is in the Monroe School District, please use The Monroe SBMH Online Form: .

All information submitted via this online form is confidential and will be used to determine need for clinical mental health support at school.

By submitting this referral you are providing consent for Avenues Counseling LLC and the Albany, Juda, or Blackhawk School District to consider mental health options for your student. No mental health services will be provided without the written consent of a parent or guardian.

If you have significant concerns about your child's safety that require immediate attention, please contact your child's pediatrician or call 911.

Should you have any questions, please contact the Staff at Avenues Counseling:
Avenues Counseling, LLC
1518 11th Street, Suite 1-4
Monroe, WI 53566
Phone: 608-325-1070
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