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Community Mental Health Provider Forms

School District of Holmen

Mental Health Provider Process

This page outlines the steps and required forms for community mental health providers to support students on school grounds.

Step 1

Complete the checklist and required forms

The first step in the mental health provider process is to complete the checklist and the following forms:

  1. Complete agency’s client intake form.
  2. Parent/guardian signed consent form from agency for mental health provider to see student at school.
  3. Parent/guardian signed release of information form for information exchange between mental health provider and school staff. Release of Information Form

Once these items are completed, district staff will review and follow up as needed.

Step 2

Schedule your visit at one of our school buildings

After completing the required checklist and forms, mental health providers must schedule their visit at the appropriate school building. Please use the links below to review building-specific calendars, schedules, room reservations, and contact information.