Heart to Heart Check-in Sheet
Heart to Heart
A space for your thoughts and feelings.
Name
Date
How's your heart feeling?
Circle the one that fits best right now:
☀️
Sunny
🌤️
Okay
☁️
Bleh
🌧️
Sad
⛈️
Angry
The Feelings List
Circle any words that describe you lately:
Excited Nervous Proud Lonely Frustrated Calm Bored Worried Grateful Tired Confused Silly Safe Invisible
How are things going?
At Home 1 --- 2 --- 3 --- 4 --- 5
With Friends 1 --- 2 --- 3 --- 4 --- 5
In Class 1 --- 2 --- 3 --- 4 --- 5
What's on your mind?
The big stuff, the small stuff, or anything in between...
Highs & Lows
One thing that went well this week:
One thing that was hard:
Talking Today
On a scale of 1-5, how much do you want to talk about these things today?
1
Not really
3
A little
5
Yes, please!
Remember: This is a safe space just for us. Your feelings matter!