Counseling Referral
If you have a student who you believe is in need of seeing a mental health or school counselor please fill out this form and submit it.
**If immediate safety concern, please contact building counseling or administrative staff directly during school hours.  

After hours if student is in immediate need of help please call:
Emergency--911
Cascade Community Healthcare Crisis Line at 1-800-803-8833 (24/7 support, Lewis County)
Text HOME to 741741 to connect with a Crisis Counselor (24/7 support, national hotline)
Sign in to Google to save your progress. Learn more
Email *
Student First Name *
Student Last Name *
What school does the student being referred attend? *
Required
Concerns *
Required
Brief description of your concerns: *
Any other comments
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Chehalis School District. Report Abuse
Google Forms