Health and wellbeing questionnaire for year 9 pupils

Confidentiality: Unless you give permission, the School Nursing Service will not pass on anything you say to anyone else, like parents, teachers, or other students – except in extreme circumstances like if the health, safety or welfare of you or someone else who is at significant risk.

Date of birth:(Required)

Name of School:(Required)

Examples of long term conditions include: Diabetes Asthma Epilepsy Mental wellbeing

Examples of disabilities include: Autism ADHD / hearing impairment / hearing loss / vision impairment / vision loss / Down Syndrome / Cerebral Palsy

If yes, what is your long term condition/illness or disability?

How does it affect your life?

If yes, what medication do you take?

How often do you take the medication?

If yes, what worries you?

The School Nurse Service can provide a wide range of confidential support.

Would you like any support with any of the areas below?

Please click yes or no on each of the areas below.

If you have answered yes to any of the above one of our friendly school nurses will be in touch to offer you help and support.

ChatHealth, is a confidential text messaging service for young people, aged 11-19, in Knowsley. You can access confidential advice and support from the school nursing team by text – 07312 263 254, on a range of health and wellbeing issues, including anxiety, bullying, relationships and emotional health.

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