Treatment Planning Worksheet
Name
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First Name
Last Name
What things may help you succeed in your goals?
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What things may prevent you from succeeding in your goals?
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What good support systems/services do you have or utilize to help you succeed?
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Do you feel that it is important to plan for your future? Explain.
*
What stage of change do you feel that you are in?
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Pre-contemplation (no intention to change in the foreseeable future)
Contemplation (know there is a problem and thinking about changing but not yet made the commitment)
Preparation (Intend on taking action in the next month and been unsuccessful in the last year at taking action)
Action (modify their behavior, experiences, or environment in order to overcome their problems)
Maintenance (work to prevent relapse and consolidate the gains attained during action)
List some healthy alternatives to your current behavioral concern:
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What are some of your strengths?
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What are some areas you are wanting to improve?
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List some long-term (5 years) goals that you want to achieve:
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List some short-term (2 years) goals that you want to achieve:
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List goals that you want to reach in treatment:
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Submit
Should be Empty: