Request to Meet with Wellness Counselor 24-25

RUHS provides professional mental health services to students in their academic setting. Our therapist and counseling interns are conveniently located right on campus. All services are free to the student and their parents. To request an appointment with a Wellness Center Counselor, please fill out the form below. We will try to see you as soon as possible. A blue slip will be sent to your class with the designated time. If you need to miss the appointment, please email us immediately so we can schedule someone else in that spot. If this is a mental health crisis, please contact 988 or go to your nearest hospital. If you or someone you know is in danger, please call 9-1-1. We look forward to meeting with you. You are very valuable to us.

Email address of person submitting form *

Student First Name *

Student Last Name *

Grade Level *

9

10

11

12

Which Wellness Center Counselor/Therapist would you like to see? *

Would you be interested in meeting with a peer counselor (RUHS student trained in helping)?

What type of meeting are you requesting? *

Who is referring student for services? *

What timeframe would be best? *

How would you prefer we contact the student for the appointment? *

Email

Call Slip

Please provide the best phone number or email address to reach the student *

Please explain your request so we can be fully prepared for our meeting. What should we know? *