School Based Therapy Referral Form

Marryland Therapy & Consultation | LeCole Barnes, LCSW

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School-based counseling is voluntary and requires parent/guardian consent before services begin. Completion of this referral does not guarantee services. A licensed clinician will review the referral and determine the appropriate level of care. If the student is experiencing a mental health emergency or is at immediate risk of harm, call 911 or go to the nearest emergency department instead of completing this referral.

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