Warrior Wellness Check-In

Who is completing this form today?

Hey Sis! 🌸
This check-in is a way to honor where you are today — no judgment, no pressure.
Whether you are filling this out for yourself or reflecting for your Little Sister, thank you for helping us walk this journey together with love and support.

Take a moment just for you. 💖
This space is yours to reflect, breathe, and share honestly about how you're feeling.
There are no wrong answers — only your truth.
We are here to listen, uplift, and walk with you every step of the way.
You are powerful. You are not alone. You are a Warrior.

Hey Sis! 💜

Thank you for being a source of encouragement, companionship, and support to your Little Sister.

This section helps My Sister's Keeper Cleveland recognize your commitment, understand the support you've provided, and identify where additional assistance may be needed.

Remember, meaningful sisterhood isn't measured by how many women you support, but by the care and consistency you provide.

Your Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Name of Little Sister

Name of Big Sister

When did you last connect with your Little Sister?

Date

A Little Reminder 💕

Your role as a Big Sister is to offer companionship, encouragement, and a listening ear. You are not expected to serve as a counselor or healthcare professional.

If your Little Sister needs additional assistance, please notify the Big Sister Coordinator via call or text (216)333-1819. Urgent concerns should be communicated directly rather than waiting for this report to be reviewed.

Thank you for showing up and making sisterhood meaningful!

How did you connect this month?

How did you support your Little Sister?

Please describe the support provided or details we should celebrate and/or barriers we can try to help mitigate.

Prefer to speak instead of type?Tap the microphone on your phone's keyboard and speak your response. Your words will automatically appear in the text box. Review your response before submitting.

Does your Little Sister need additional support?

If Yes or Unsure, please describe support needed.

Prefer to speak instead of type?Tap the microphone on your phone's keyboard and speak your response. Your words will automatically appear in the text box. Review your response before submitting.

Have you notified the Big Sister Coordinator?

How are you feeling in these areas today?

Rows	Really having a hard time	Struggling a bit	Hanging in there	Doing well most days	Feeling strong and steady
My appetite and ability to nourish myself
My emotional well-being and mood
My level of worry or anxiety
My financial situation
My housing and transportation stability
My family and support system connections
My understanding of my treatment plan and next steps

Appetite

Emotions

Worry

Finance

Housing/Transportation

Treatment

Support

Wellness Score

Ready to move to the Middle Sister Program?

Your voice matters.

Would you like to share anything more with us?

Physical challenges or symptoms you are facing:

Prefer to speak instead of type?Tap the microphone on your phone's keyboard and speak your response. Your words will automatically appear in the text box. Review your response before submitting.

Anything else you’d like us to know today?

Prefer to speak instead of type?Tap the microphone on your phone's keyboard and speak your response. Your words will automatically appear in the text box. Review your response before submitting.

One strength, hope, or blessing you're holding onto today:

Prefer to speak instead of type?Tap the microphone on your phone's keyboard and speak your response. Your words will automatically appear in the text box. Review your response before submitting.

Would you like someone from our Sister Support Team to connect with you?

Other

🌸 Our Promise to You:

Everything you share is treated with compassion, respect, and confidentiality.
If your responses show that you might need extra support, a member of our Sister Support Team may reach out to you.

We are here to walk beside you — never to pressure you, only to uplift and support you.

If MySKCle needs to follow up with you based on your answers, how would you like us to reach you?

By submitting this check-in, I understand that My Sister’s Keeper-Cleveland may contact me based on the contact method I selected.