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College Now Mental Health Referral Form

Please fill out the form below to submit a referral for Beech Brook's College Now services.

Anger Management (arguing, irritability, fighting, yelling, etc.)
Trauma/PTSD (abuse, domestic violence, witness trauma, etc.)
Depressed Mood (overall sadness, low/restricted activity levels, crying, poor appetite)
Anxiety (acting in a fearful manner, appears overly stressed, inability to cope with daily functioning, panic)
Adjustment (recent changes or stressors impacting functioning)
Other

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