RHS Wellness Form

Pod October 21, 2020

If an emergency call 911

Crisis Lines for Help and Support

Crisis Line: 1-800-985-5990

Sacramento County Suicide Prevention Hotline: 916-368-3111

Mental Health Urgent Care: 916-520-2460

Call or text 24 hours a day for help for youth and caregivers: 916-SUPPORT

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Crisis Text Line (text) 741741

Student Name: *

Student Cell Phone Number: *

Who is your Rosemont High School Counselor: *

What is concerning you or would you like help with? : *

Attendance

Academic

Family stress

Food, clothing or shelter

Gender or sexual identity

Health (physical, dental or vision - explain below)

Homelessness

Mental health (symptoms may include, but are not limited to: can’t sleep, sadness, excessive crying, loneliness, loss of appetite, lack of concentration, relationship stress, excessive worry)

Racial discrimination or hate crime

Please provide a more detailed description of these issues and any other concerns:

RHS Wellness Form

Crisis Lines for Help and Support

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