This form is intended for use of referring students for case management services provided by the Health and Wellness Case Manager.

Any person can complete and submit the referral to Health and Wellness Case Management Services.

Please complete this form completely and submit to the Health and Wellness Case Manager.

If you have any questions or need assistance completing this referral form please contact the Health and Wellness Case Manager.

It is recommended, but not necessary, that this referral is completed collaboratively with the student.

Please inform the student that a referral has been submitted on their behalf to promote prompt access to services.

Contact Us

If you have any questions or need assistance completing this form, please reach out to The Health and Wellness Case Manager at (570) 422-2845

Contact Information

Campus Address
Sycamore Suites, Lower Level, 041
Phone:
(570) 422-2845
Title of Department Leader
Case Manager
Name
Bailey Higgins
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