Student Mental Health Check Form

Student Mental Health Check Form
Name
First NameLast Name
Student Number
How was your sleep night?

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10
1 is Didn't Sleep At All, 10 is Best Sleep Ever
How was breakfast or lunch?

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10
1 is Skipped Breakfast/Lunch, 10 is I'm Full
How are you today?

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9
10
1 is I'm In a Dark Place, 10 is I'm Great!
How are things outside of the school?

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10
1 is Horrible, 10 is Things are great!
Anything you want to tell us?
Should be Empty:

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