Student Daily Wellness Assessment Form
Student Daily Wellness Assessment Form
Please fill out this form to assess your daily wellness and track your overall well-being.
Personal Information
Name
Grade/Year
Date
Physical Wellness
On a scale of 1 to 10, how would you rate your physical health today?
Any physical discomfort or symptoms?
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Headache
-
Fatigue
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Soreness
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Nauseous
-
Emotional Wellness
On a scale of 1 to 10, how would you rate your emotional state today?
Any notable emotions you experienced today?
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Joy
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Sadness
-
Stress
-
Mental Wellness
On a scale of 1 to 10, how would you rate your mental clarity and focus today?
Any challenges with concentration or focus?
Social Wellness
Did you interact with others today?
If yes, how would you rate your social interaction?
Daily Reflection
Any positive experiences, challenges, or thoughts you'd like to share today?
Please check the box below to proceed
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