Crisis/Risk Assessment

ESE Mental Health Crisis/Risk Assessment
Student Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
School
Legal Guardian

First NameLast Name
Legal Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Legal Guardian Email
example@example.com
School Counselor

First NameLast Name
School Counselor Email
example@example.com
School Counselor Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Incident

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Where is the student at?
Description of Incident
A crisis assessment would involve students who are currently in school and actively presenting with suicidal or homicidal ideation or behaviors that require immediate evaluation and intervention.

A risk assessment, on the other hand, is typically for students who are not currently in school and need to be evaluated to determine whether they can safely return to school following a concerning statement or incident.
Type of assessment
Is patient receiving outside services?
Where are they receiving services?
Crisis / Risk Assessment Disclaimer:
All crisis and risk assessments will be addressed within 24 hours of receiving the completed online registration from the parent/guardian. A therapist will contact the parent/guardian as soon as they are able, based on their availability.

To help expedite the process, if the student has not previously been seen by ESE Mental Health, please have the parent/guardian complete the online registration using the link below:

ESE Mental Health Registration Link:
Teletherapy Registration – ESE Telehealth
Should be Empty:

ESE Mental Health Crisis/Risk Assessment