Referral Forms

SMMUSD Mental Health Referral Form

If you know you would like ongoing weekly individual sessions, group counseling, or substance use counseling through our network of Samohi therapists, download and fill out the SMMUSD Mental Health Referral form. *Please note you must download the form and submit to slotan@smmusd.org

Student Disclaimer:  If I am student completing this form, I understand that school staff may not receive this request immediately. If this is a crisis I will contact 911. I also understand that if I disclose that I am thinking of hurting myself or someone else, or if I disclose that someone has hurt or is hurting me, this information cannot be kept confidential. 

If you would like help connecting to mental health services outside of the school system, contact the district Mental Health Counseling Coordinator at slotan@smmusd.org.