INTRODUCTION AND PURPOSE: School health services is an important element in many countries' health promotion activities but little is known about the pupils' acceptance and perception of these services and their effects. The objective of this paper was to examine the pupils' self-reported outcome of the health dialogue and to examine the effect of social class on this response controlled for the effect of other relevant social factors. MATERIAL AND METHODS: The study is a survey. The population were all pupils in the fifth, seventh and ninth grade (11, 13 and 15 years old) in a random sample of schools in Denmark, response rate 87%, n = 5205. Data were collected by questionnaires. RESULTS: The majority of the pupils had reflected about the content of the last health dialogue with the school health nurse (54%), had discussed the content with their mother (62%) and with friends (54%); 62% had followed the nurse's advice, 77% had made their own autonomous decisions based on the health dialogue, and 11% had returned to the nurse for further advice. Pupils from the lower social classes had more often followed the nurse's advice (OR = 1.16, 95% CI: 0.99-1.37) and returned to the nurse (OR = 1.46, 95% CI: 1.12-1.90). Pupils from the middle and lower social classes had more often made their own autonomous decisions (middle social classes: OR =1.23, 95% CI: 1.08-1.39, lower social classes: OR = 1.13, 95% CI: 0.95-1.34). CONCLUSION: Most pupils reported an outcome of the health dialogue with the school health nurse. Pupils from lower social classes seemed to benefit more than pupils from higher social classes.