Counseling Forms

Click on the links below for the appropriate form:

School Health and Wellness Referral Form
Student Referral form: used to initiate an intake appointment for a student with H&W staff.  After completing the form, click "Submit" and it will automatically be sent to Hannah Haikin, LPC, Health and Wellness Program Coordinator. 

Staff Counseling Request Form
Staff Referral Form: used to initiate an intake appointment for DC faculty and staff with SHWP staff.  After completing the form, click submit and it will automatically be sent to Hannah Haikin, LPC, Health and Wellness Program Assistant Coordinator. 

Student Connection Group Information Flyer
Student Connection
 Group Form


Website by SchoolMessenger Presence. © 2022 Intrado Corporation. All rights reserved.