Hillside New Student Registration

Zebra Health+Digital is providing online mental health counseling for students!

We are ready to assist.

We are proud to have partnered with numerous school districts, achieving remarkable results in enhancing students’ mental health and well-being. Our proven track record of success demonstrates our commitment and effectiveness in supporting children. These positive outcomes inspire us to maintain the highest standards in mental health telehealth services. Trust us to provide your child with the professional care they deserve, ensuring they thrive both emotionally and academically.

Our therapists are here to support you!

We have several amazing therapists to help you achieve your goals. You can receive a 30-min video intake session and 30-min video follow up sessions with one of our therapists:

Have all 3 consents been signed and sent to Zebra?

Please ensure that all 3 consent forms have been signed and sent before proceeding.

Name of person completing the form

First Name

Last Name

Is therapy for a staff member or a student?

Client's full name

First Name

Last Name

Client's gender

Client's Date of Birth

MM

DD

YYYY

Client's grade level

Client's school / district

Client's preferred day and time for sessions

Please indicate if the client will benefit from any additional session options:

After School

Weekend

At Home

Client's email address

For a student, this will be their student email. For an adult, this will be their personal email.

Guardian's Full Name

First Name

Last Name

Guardian's phone

(###)

###

####

Guardian's email address

Additional information

Reason for visit, general diagnosis based on prior years' report, language preference, or any information we should know

Hillside New Student Registration

Zebra Health+Digital is providing online mental health counseling for students!

We are ready to assist.

Our therapists are here to support you!

Zebra Health + Digital

hello@zebrahd.com