Pupil Mental Health and Well-Being Review

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A questionnaire for parents and carers

Email *

Pupil Name *

Year Group *

Nursery/Pre-school

Reception

Nurture

Butterflies

On a scale of 1 - 5 how well do you think your child coped with the return to school in September? *

1 - Easy no concerns at all

2 - Slight concerns but was fine overall

3 - Needed some extra support

4 - Definite guidance and support needed

5 - Has really struggled - did not or almost didn't return

How concerned are you currently about your child's mental health and well-being? 5 being very concerned and 0 being not concerned at all *

If you have concerns about your child's mental health and well-being please describe them: *

Would you like your child to receive some additional support for their Mental Health and Well-Being? *

Yes

Maybe

If you answered Yes above would you like someone to contact you to discuss support options? *

Yes

Have you ever tried to get support for your child's mental health and well-being from other agencies for example your GP *

Yes

If you answered yes who did you contact? *

Are you aware of any local services and organisations that can help support child mental health and well-being? *

Yes

If you answered yes above, what services are you aware of? *

If you have any questions or comments regarding MHWB please add them below: *

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