Kamusta Ka? Form

1

Hello, there!What's your name? (You can remain anonymous if you want to. You can just skip this part.)

First Name

Last Name

3

How can we reach you?

Provider

Phone Number

4

Are there any special things that we need to know? (e.g. health conditions, pronouns, et cetera)You can skip this part if there are none.

5

Would this be okay with you?We would want to listen and help out in the best way we can.

YESNO

6

What's going on?Please share what's on your mind.

7

Can we reach out to you after this concern?If yes, how do you want the batch council to reach out? (N/A if no).

8

Is there anything else we can help with?The Department of Internals are very much willing to facilitate the process of getting services from the school so they could help you.

Acute Care Services (from Health Services)

Mental Health Services (from Health Services)

Kwento Session (from VP for Internals)

Other health services (e.g. medcerts, referrals, health assessment, etc.) (from Health Services)