1.What insurance do you have?

Medicaid

Private Non-Medicaid

I don't have any

2.Do you have a preference of which agency? If so, please list.

Chrysalis BayCareHEADSSequel LifespanI need help decidingI want the school social worker or counselor at Cypress to meet with my child

3.Would you like in person or virtual?

In PersonVirtual

4.This is my child's name or student ID #

5.This is my name