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Check-in with Mrs. Harris
I am checking in to see how you are doing and to see if there is anything that I can help with. Answer as many or as few as you'd like-the more, the better! Your counselor loves you!
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Hello and thanks for visiting!
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DD
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YYYY
Time
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AM
PM
First Name
*
Your answer
Last Name
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Your answer
How are you feeling today?
1 - Not good at all - I need a check in call
2 - Could be better
3 - Okay
4 - Pretty Good
5 - Great
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How is everything at home?
Your answer
What are some things that you can do when you have BIG feelings (sad, mad, nervous, scared)?
Your answer
What are some activities that you like to do while you are at home? Things I enjoy are...
Your answer
Do you need a check in call?
Yes
No
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Anything else you would like to share?
Your answer
If you would like me to call to check in, please list best time to call and phone number.
Your answer
If you are a parent/guardian and would like me to contact you please leave your name, student's name, phone number and best time to call.
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