Staff
Client Tracking
Enter Phone Number
Digits only (e.g., 8885551212)
Format: (000) 000-0000.
If Student, Enter Student ID
Enter Student ID
Enter Your 9 Digit School ID
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Check In Form
Neighborhood Wellness
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Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Student ID
Date
*
-
Month
-
Day
Year
Date
Race/Ethnicity
*
African American
Hispanic
AAPI
White
Afghan/Middle Eastern
Native American
Client Encounter
*
Healing Circle
Parent Cafe
Unhoused
School
Other
Reason for Check In
School
Please Select
Grant HS
MKL
SCOE
Woodlake
Client Services
Parent/caregiver Engagement
Mentoring
Attendance, Suspension, Truancy Interventions
Care Coordination
Behavioral Health
HMIS
Educational Sessions/Training
Vocational Training
Career Matriculation
Birthday
-
Month
-
Day
Year
Date
Staff
Please Select
Charles
Dooney
Fade
Gina
Gustavo
John
Jovanie
Laurel
Laurin
Les
Marilyn
Pinkey
Renea
Sam
Sherri
Sonia
Sherri
Follow-Up
Follow Up Date
-
Month
-
Day
Year
Date
File Upload (Only if you have received permission, NO file upload for students)
Browse Files
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of
Signature
Lead Staff
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Contact ID
Contact ID from Salesforce record if Phone Number match is found.
Should be Empty: