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Student Wellness Check-In Form - Free Education Template | ZenBuild | ZenBuild

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Student Wellness Check-In Form

Collect regular wellness check-ins from students to help counselors monitor mental health and wellbeing.

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Student Wellness Check-In Form

Collect regular wellness check-ins from students to help counselors monitor mental health and wellbeing.

First Name*

Grade or Year*

How are you feeling overall this week?*

I have been experiencing (check all that apply)

Stress about schoolworkAnxietyDifficulty sleepingLonelinessFamily concernsDifficulties with peersNothing significant

Would you like to speak with a school counselor?*

YesNoMaybe later

Is there anything specific you'd like support with?

Is this okay to share with your counselor?*

YesNo

Template Details

CategoryEducation

IndustryEducation

Fields7

Uses0

Views1

wellnessmental healthstudent supportcounseling