Forms

MPUSD Parents

Choose this option if you would like to submit a request for your child to enroll in counseling. 


Students

For students who would like to speak to a counselor (informally)


Students (Click here )

MPUSD Staff 

For MPUSD teachers and staff who would like to submit a counseling referral 

Parent Intake Forms 

Notice of Privacy 

Telehealth Informed Consent

English Version 

Spanish Version  

Seven Challenges

English and Spanish 

Bring this form along with a copy of the front/back of students insurance cards (applies to Medi-Cal patients only).