About this template
Checking in on student wellbeing is essential for academic success and personal growth. This Student Mental Health Check form is designed specifically for school psychologists, guidance counselors, and educators to proactively monitor how students are feeling throughout the school year. By offering a structured, low-pressure way for students to share their current emotional state, sleep patterns, and daily habits, schools can identify who might need extra support or intervention before small challenges become overwhelming.
The form collects vital insights into a student's daily routine, including sleep quality, nutrition habits, and outside-school wellbeing, while maintaining a supportive and approachable tone. Designed for easy deployment via Doc2Form, educators can instantly convert this template into a Google Form and share it securely with students.
Whether used as a weekly check-in, part of a remote learning support initiative, or as a preventative mental health screen, this template streamlines how schools gather sensitive data while protecting student privacy. Use it to foster a caring school culture and ensure every student knows where to turn for help.
Key features
- Assess sleep quality and daily nutrition habits quickly.
- Gauge overall emotional wellbeing both inside and outside of school.
- Provide a safe outlet for students to request support.
- Streamline data collection for school counselors and mental health teams.
Use cases
Weekly or monthly wellness check-ins for high school and middle schoo…
Weekly or monthly wellness check-ins for high school and middle school students.
Remote learning pastoral care and student support tracking.
School psychologist intake screenings for counseling referrals.
Advisory period wellbeing assessments.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Student ID Number (Short answer)Enter your school identification number.
- Current Grade Level (Dropdown)Select your current grade.
- How are you feeling today overall? (Multiple choice)Select the option that best describes your current mood.
- Sleep Quality Rating (Linear scale)How well have you been sleeping over the past week?
- Nutrition & Meals Rating (Linear scale)How satisfied are you with your regular access to healthy meals (breakfast and lunch)?
- Outside School Wellbeing Rating (Linear scale)How do you feel about your life outside of school (home life, friends, hobbies)?
- Would you like to speak with a school counselor? (Multiple choice)Select yes if you would like someone to reach out to you privately.
- Additional Comments or Concerns (Paragraph)Share anything else on your mind that you would like the counseling team to know.
FAQ
How can I customize this template for my school?
With Doc2Form, you can instantly convert this template into a Google Form, where you can easily edit questions, add your school logo, and adjust settings to match your district's guidelines.
Is this form suitable for remote or hybrid students?
Yes! You can share the Google Form link via email, student portals, or learning management systems so students can check in from anywhere.
Can students request to speak with a counselor through this form?
Yes, you can add a follow-up question allowing students to explicitly request a meeting with a school counselor or psychologist based on their check-in.
How do I ensure student responses remain confidential?
Google Forms allows you to restrict responses to your school's domain or keep submissions anonymous depending on your counseling policy and privacy requirements.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.