Mental Health Consent Form

As a member of the Ann K. Heiman community, your student has the privilege of receiving support from our School Counselor. Ways that our School Counselor supports students is through check-in sessions, social skills groups, academic groups, social emotional learning groups, classroom social emotional learning lessons, and/or individual counseling. In order to provide this service on a regular basis, your permission is necessary. Check-ins are generally provided for a 6 to 8 week period, at which time continued need for check-ins can be determined. Parents/Guardians will be notified if ongoing counseling services are needed. At that time, parents/guardians will decide if school counseling services may continue. (Please note: in a crisis, any child can receive crisis intervention and counseling without prior permission). Any regular and ongoing counseling information is kept confidential unless the student is at-risk of being harmed, hurting him/herself or others. In such a case as when the student's safety or the safety of others is questionable, the parent must be notified and proper referrals made. 


Please sign the form if you do not give permission for your student to receive supporrt from our School Counselor. 

Heiman Counseling Consent Form - Google Docs.pdf, 70.37 KB; (Last Modified on January 6, 2020)