Template Mental Health Student Health and Wellness Audit Form Template

Student Health and Wellness Audit Form Template

Student Health and Wellness Audit Form Template

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Student Health and Wellness Audit Form Template

Please complete this form to help us evaluate your current health and wellness.
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*
1.
Student's full name
2.
Student's date of birth
3.
Gender identity
Female
Male
Non-binary
Prefer not to say
4.
Do you have any allergies?
Yes
No
5.
If yes, please list your allergies
6.
Do you have any chronic health conditions?
Yes
No
7.
If yes, please list your chronic health conditions
8.
On average, how many hours of sleep do you get per night?
9.
How many times per week do you engage in physical activity?
Never
1-2 times per week
3-4 times per week
5 or more times per week
10.
Rate your overall wellness on a scale of 1 to 10
11.
Do you have any dietary restrictions?
Yes
No
12.
If yes, please list your dietary restrictions
13.
Any additional comments or concerns?
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Template instructions
Student health and wellness audit form template helps educational institutions assess students' physical, emotional, and mental health needs. Use this form to collect personal and medical information that informs interventions and wellness programming. Administrators can identify students needing accommodations, and educators can adapt supports. The collected data also helps identify trends, allocate resources, and justify wellness program funding and staff training.

The template contains fields for student full name, date of birth, gender, allergies, chronic conditions, sleep hours, exercise frequency, wellness rating, dietary restrictions, and additional comments. Conditional logic supports follow-up prompts when respondents indicate concerns.

Appropriate for school nurses, counselors, administrators, and health coordinators, this form supports intake assessments, trend monitoring, and program planning. It is fully customizable with integrations and privacy controls to protect sensitive data.

Click "Use This Template" to begin using this free template and tailor it to your institution's reporting and student support needs effectively.

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