Please answer the following questions for the health inspection. Any information you provide is confidential and will only be used by the health care department. 
	
1. Pupil’s personal information	Last name and first name
     	Personal identity number
     	
	Address
     	Home municipality
     	
	Programme/group
     	Phone number
     	
	Guardian or close relative 
     	Phone number
     	
2. Studying	How do you find your ability to study? (E.g. health, resources, study skills, learning environment, possible learning difficulties, need for special support)
     	
	How are your current studies going? (E.g. learning environment, absences, financial situation, living arrangements)
     	
3. Health routines	What are your eating habits like?
     	
	Amount of sleep at weekdays?
                hours/night	Amount of sleep at weekends?
                hours/night	
	Is anything bothering your sleep? Please specify.
     	
	Do you smoke or use snuff?
     	How much do you smoke or use snuff? 
     	
	Do you use alcohol?
     	How often do you use alcohol / How much do you use alcohol at a time?
     	
	Have you tried or are you using drugs?
     	
	How do you relax and spend your free time?
      	
	Describe your current exercise habits.
     	
4. Sexual health	How do you find your sexual health?
     	
	Do you need to use protection?
     	
	Do you have any questions related to sexuality or sexual identity?
     	
	Have you experienced physical or mental abuse? (Name-calling, inappropriate touching, sexual molestation, violence)?
     	
5. Health	Do you feel healthy?
     
	
	What can you do to impact your health?
     
	
	Do you have any diagnosed diseases? Place of care?
     
	
	Do you often experience headache, stomach pain, nervousness, fears or other unordinary circumstances?
     

	Do you take any medication occasionally or regularly? Please specify.
     
	
	Are there any matters related to your health which may impact your future job?
     	
	Are you worried about something related to your health?
     	
6. Wellbeing and ability to cope	Are you happy with yourself and your life?
     
	
	Has anything of particular significance happened in your life?
     
	
	Do you have anyone close to you who you can talk about matters that are important to you?
     
	
	How happy are you with your relationships?
     
	
	What are you hoping to accomplish in the future?
     
	
	Do you have any matters related to health and well-being you wish to discuss?
     
	
7. Signature	Date and signature

     	

Thank you for your answers!