School District Referral Form — LexiRose Psychological Services
LexiRose Psychological Services

For Schools & Districts

School District Referral Form

Tell us a little about your district and the support you’re seeking. We’ll follow up to discuss scope, timing, and next steps.

This form is for district and school partnership inquiries. For individual or family services, please use our New Client Inquiry form instead.
1

District Information

Please enter the school district name.

2

Primary Contact

Please enter a contact name.

Please enter a valid email address.

Please enter a phone number.

3

Services Requested

Check all that apply.

4

Student Population

Check all that apply.

5

Scope & Timeline
6

Additional Information

Please share any additional details that may help us understand your district’s needs.

Fields marked * are required. We typically respond within 1–2 business days.

Thank you for reaching out

Thank you for considering LexiRose Psychological Services. We look forward to supporting your students, staff, and district through high-quality, collaborative services. We’ve received your inquiry and will be in touch within 1–2 business days.

If you need to reach us sooner, call 916-304-4995.