Request A Check-In

Please click on the link below and complete form to request a counselor check-in.

The counselor or therapist will be in contact with you within 24 hours.

All information shared in this form will be kept confidential.


If this is an immediate crisis, please talk to a trusted adult or call/ text the National Suicide Prevention Lifeline at 988 for suicide crisis or emotional distress. If you are having a mental health or life-threatening emergency, please call 911 or go to the nearest hospital immediately.

Counseling Referral Form