Skip to content
Student Referral - Wellbeing Support
1.
I understand that responses to this form are not monitored outside of school hours and that if I need immediate help I will call 000, Kids Helpline 1800 551 800 or Lifeline 13 11 44.
Yes
2.
What is your name?
3.
What is your email?
4.
What year are you in?
7
8
9
10
11
12
5.
Who would you like to speak to?
Elise Purnell - School Counsellor / Registered Psychologist
Jessica Liardo - School Psychologist / Registered Psychologist
I don't mind
6.
What would you like support with? (tick all that apply)
I am feeling stressed
I am having trouble with friends
I am having trouble managing my schoolwork
I am feeling low / disconnected
I am struggling with my mental health
I am having issues at home
I am struggling to find motivation
I am worried about someone I care about
Other
7.
Are you currently seeing anyone to support your mental health (e.g. psychologist / counsellor)?
Yes
No
8.
What would you like to get out of meeting with SSO/SC/SP?
9.
Would you like to add anything else about what you are experiencing at the moment?
Current Progress,
0 of 9 answered