2026-27 Grand Ledge School-Based Health Center Behavior/Mental Health Services Referral Form

The 2026 - 2027 Grand Ledge School-Based Health Center Behavior/Mental Health Services Referral Form can be completed at any time to submit a request for a student to receive services.  It is not necessary to know which service you are asking for or which specialist would be most appropriate.  Just answer a few questions and we will take it from there.  The referral will go to the Eaton RESA Behavior/Mental Health Department, and we will review and assign the student as needed - this includes creating customized interventions.

Whether we need to reach out for more information or we begin the consent process, we attempt to review all referrals within 7 days and assign them to a specialist within 30 days.  Please note - the form is not intended for emergency or crisis situations. 

For assistance completing this form, please contact Heather Morehouse at 517.541.8941.

Referral Source Information
Participants Information
Participant's sex
Participant gender identity
Is Participant a minor?   (required)
Parent/Guardian Information
If yes, does a parent/guardian know that services are being requested?   (required)
Parent/Guardian Information
Referral Details
Tentative referral services requested (check all that apply):   (required)
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