Student Mental Health Survey and Referral Form
Form Template
Use this app to refer a student you suspect of needing mental health services and resources.
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The information provided in the survey will be review by the School Counselor and/or Principal. The Student Mental Health Survey and Referral Form mobile app allows you to replace your paper referral form with a handheld mobile device like a smartphone or tablet. The mobile form includes fields to document items such as date of referral, area(s) of concern, duration, severity, and impact of the concerns. Once the mobile app is filled out a secure PDF is generated. The PDF is easy to share, and a copy is stored in your account for your education records. You can also use the App Builder to personalize and customize this mobile form.
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