Support Group Check-In Survey Form
A simple, polished check-in survey for support group members to share how they are doing, what was helpful, and what they would like next.
Check-In Details
Preferred Name
*
Check-In Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Group/Session Name or Topic
*
Please Select
General Support
Anxiety Support
Depression Support
Grief Support
Family Support
Other
Support Group Survey Questions
Mood or emotional state today
*
Very low
Low
Neutral
Good
Very good
Overall sense of support from the group
*
Not supported
1
2
3
4
Very supported
5
1 is Not supported, 5 is Very supported
How connected do you feel to others in the group?
*
Not connected
1
2
3
4
Very connected
5
1 is Not connected, 5 is Very connected
Usefulness of today's discussion
*
Not useful
1
2
3
4
Very useful
5
1 is Not useful, 5 is Very useful
Quick check-in statements
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I felt heard today
1
2
3
4
5
I was comfortable participating
6
7
8
9
10
I left the session feeling hopeful
11
12
13
14
15
Follow-Up
What helped you most or what would improve future sessions?
Preferred follow-up topic or support need for the next meeting
Please Select
Stress management
Peer sharing
Resource referrals
Coping strategies
Communication skills
Other
Submit
Should be Empty: