Mrs. Benny Check - In Chequeo

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Hi,
This form will help me learn about how are you doing.

Hola,
Esta forma me va a yudar a saber como estas haciendo.

Untitled Title

Fecha *

YYYY

Name and last Name (Nombre y Apellido) *

How am feeling. Como me estoy sintiendo.

How are you doing today? Como estas haciendo hoy? *

Great

Good

It could be better (I would like a check-in phone call)

Name 1 - 2 coping strategies or activities you can do to help your body and mind. Escribe 1-2 estrategias o actividades que puedes hacer para ayudar a tu mente y cuerpo.

Here are some ideas of activities that you can use. Check the activity/coping tool you would like to use to take care of yourself today. Aqui vas a ver algunas actividades que puedes usar. Escoge la actividad o herramienta que vas a usar hoy para cuidarte.

Draw a picture (dibujar)

Listen to music (escuchar a la musica)

Take deep breaths or blow bubbles (respira profundo o usas bubbles)

Dance or move my body (bailar o mover mi cuerpo)

God for a bike ride, walk, or run (correr una bicicleta, caminar o correr)

Strecht (estirar to cuerpo)

Eat healthy food (comer comida saludable)

Drink lots of water (tomar mucha agua)

Talk to a trusted friend (hablar con un amigo (a) de confianza)

Write on a journal or notebook (escribir en un jornal o libreta)

Talk to a trusted grown up (hablar con un adulto de confianza)

Read a book or research a topic I like (leer un libro o buscar un tema que me gusta en la internet)

Smile and laugh at something funny (sonrie y riete de algo gracioso)

Play a board game with family (jugar un juego con la familia)

Help out cooking a healthy meal or a snack (ayuda a cocinar o preparar un snack)

Help out with choes at home (ayudar con tareas en la casa)

Positive things that happened today. (cosas positivas que pasaron hoy).

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