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School Based Mental Health Therapy Referral Form

School Based Mental Health Therapy Referral Form

School Based Mental Health Form
*If the student is being cared for by anyone other than a biological or adoptive parent, a court order for legal custody/guardianship must be reviewed and approved by Samaritan Counseling Center before services can be rendered. Please send a copy of the court order with the referral, if possible. If you have any questions or concerns regarding a student’s situation, please call 920-886-9319.
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