The "Counseling Referral Form" that I am posting is one that Ms. Waggoner (my colleague) and I are using this year with our students. It's a combined version of what we used last year in our counseling program and from an idea that I found on Pinterest over the summer from The Inspired Counselor. (For more information about The Inspired Counselor's forms, click here.) Ms. Waggoner and I make these forms accessible to our students by posting them outside our office. We also supply each teacher with his/her own stack of counseling referral forms for their classroom so that students will have access to them there, as well.
Once students have filled out their "Counseling Referral Form", they may put their slip of paper in my mailbox outside my door. Depending on how busy my schedule is that day, I will call the student to my office before/after my classes, meetings, etc. Of course, emergencies and urgent situations take first priority.
I LOVE, LOVE, LOVE Marissa Rex's Website!!! The "Students To See" form is a wonderful resource that she created I have used many times in the past and it is one that I am currently using this year when scheduling individual appointments. After I receive a "Counseling Referral Form" in my mailbox, I use this form by writing down the student's name, their grade level and their teacher's name. Since we request that the student explain briefly why they need to see the counselor on the back of the referral form, I like to jot down that information as a reminder for when I meet with the student and we are addressing their problem(s); therefore, I tweaked the "Students To See" form just a little to fit my personal needs. I put an "issue" column on the right hand side of the form and use this area to write down the issue(s) the child is having that he/she needs to discuss during our session together.