Wellness Center Check-In Form
Please complete the short survey below if you would like to check-In with Mrs. Doherty!

Welcome to Mrs. Doherty's Wellness Center check-in!  If you would like to connect please answer just a few questions in order to help me better understand your feelings and needs.

Thinking of you!

Mrs. Doherty

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Email *
What is your first name? *
What is your last name? *
Date *
Time *
What grade are you in? *
How are you feeling *
What calm down skills did you try?
After using that skill, how do you feel?
Not better at all
So much better
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What would be helpful for you right now? *
Add your contact information if you would like me to follow-up with you,  (Email and/or phone number). *
Thank you!  I will be contacting you soon.
You are worth it!
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