Submit a Referral

Thank you for taking the time to share your concern for one of our students. Wake Forest University School of Medicine faculty, staff, students and others are encouraged to refer students who may be struggling with academic, personal, or emotional challenges OR who may be exhibiting threatening, worrisome, or other concerning behavior to the CARE Team. Your referral supports students by helping them get connected to resources for success and helps us to maintain a healthy and safer campus environment.

IF THIS IS AN EMERGENCY THAT INVOLVES AN IMMINENT RISK OF HARM TO SELF OR OTHERS, CALL 911! FOR THE SECURITY DESK CALL 336-713-1568

To better assist us, CARE referrals should only include objective, observable and factual information. We ask that you avoid labels, stereotypes, and referrals based on hearsay or assumptions. Referrals are reviewed during normal business hours and are not monitored after hours, on weekends or during official University holidays. If you have questions about a referral you have made, please e-mail careteam@wakehealth.edu.

A member of the CARE Team will evaluate the referral and determine what follow-up (if any) is necessary to address the concerns. We take care to preserve the identity of the referring party, however, we cannot promise anonymity. Please provide your name and contact information to allow us to call or e-mail if we have additional questions regarding your report.

*If this is an emergency that is an imminent risk of harm to self or others, call 911. For the security desk, call 336-713-1568

Tell Us Who You Are Concerned About

Please list the individual(s) involved, including as many of the listed fields as you can provide. Fields may be left blank if information is not known at the time of the report. If you are concerned about yourself or would like to make a self-referral to our office, please submit your information below.

Tell Us About Your Concerns

Your concern may include indicators from multiple categories. Please select all indicators that apply to your concern. Please note that this information is not required.

For each indicated concern and/or observed behavior, please provide a detailed description in the box toward the end of this form.

I understand that if this is an emergency or imminent concern, I need to call 911 (campus phone) or the security desk at 336-713-1568 immediately and then complete a Student Outreach and Support Referral.

Do you wish to remain anonymous if/when the student is contacted? If it is your preference to remain anonymous, the CARE Team will make every effort to maintain anonymity. However, please know anonymity can never be guaranteed and students often appreciate knowing who cared about them enough to make a referral. Additionally, the CARE Team may need to follow up with you to gather additional information to most effectively support the student.

I UNDERSTAND THAT THIS FORM WILL BE SUBMITTED TO AN INBOX THAT IS NOT MONITORED 24/7 AND SHOULD NOT BE USED IN THE CASE OF AN EMERGENCY OR IF THERE IS AN IMMEDIATE THREAT TO SAFETY AND/OR LIFE. I ACKNOWLEDGE THAT IN SUCH INSTANCES, 911 OR UNIVERSITY POLICE SHOULD BE CALLED BY DIALING 336.758.5911.