TRANSITION SESSIONS
PARTICIPANT NAME
*
SESSION DATE
*
/
Month
/
Day
Year
(Please put the date that you attended the group)
TOPIC
*
Please Select
Re-Entry #1: Refusal Skills
Re-Entry #2: Anger & Resentment
Re-Entry #3: Signs of Relapse
Re-Entry #4: Decision Making Skills
Re-Entry #5: Assertiveness
Re-Entry #6: Keys to Recovery
Please choose the topic provided by the counselor from the dropdown.
TOPIC
Time
In
*
Out
*
1. EMPLOYMENT
*
Employed
Unemployed
Interviewing
Mailing Resumes
Newspaper
Comments
*
2. FAMILY RELATIONSHIP
*
Same
Improving
Increased Communication
Identifying Problems
Comments
*
3. COMMUNITY RESOURCES
*
Edd Office
Church
County Programs
Work/Education Schools
Comments
*
4. SELF-HELP GROUPS
*
None
Attending: AA
CA
CODA
Other
Weekly
Bi-Weekly
Comments
*
5. Personal Goals: improvement in
*
Positive Thinking
Behavior
Attitude
Sober Lifestyle
Comments
*
6. RELAPSE PREVENTION
*
Identifying Risk
Lifestyle Changes
Recognizing Symptoms
Comments
*
ADDITIONAL COMMENTS
*
I UNDERSTAND THAT ALCOHOL IMPAIRS MY ABILITY TO DRIVE AND IUNDERSTAND THE DANGEROUS CONSEQUENCES OF DRIKING AND DRIVING.
Signature
*
Email
*
example@example.com
DATE
*
/
Month
/
Day
Year
(Please put the date that you attended the group)
Location
*
Please Select
Jackson-Bibby - Redlands
Jackson-Bibby - Victorville
Jackson-Bibby - Barstow
The bottom portion of this form will be completed by an employee of Jackson Bibby.
Please leave blank.
ATTITUDE
Enthusiastic
Cooperative
Passive-resistant
Uncooperative
BEHAVIOR:
Appropriate; aware of responsibilities as group member
Behaves appropriately in group
Unsure of group member role
Inappropriate; disruptive to group process
COMMUNICATION
Extremely verbal
Moderately communicative
Quiet; responds when asked
No communications
GROUP LEADER
DATE
/
Month
/
Day
Year
Date
On submitting the form, the form(s) will be emailed directly to Jackson-Bibby.
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