Wellness Team Referral
Please complete the following questions and someone from the PCI wellness team will follow up as soon as possible.

** If this is a medical or psychiatric emergency, please call 911 immediately. **
  • Name of person completing this form. (This is optional).
  • Name of the student who needs support.
  • Please enter your phone number if you would like us to follow up with you.
  • Please enter a phone number, email, or social media account name for the student who needs support. (You may also enter their teacher name or school site if you know it).