COUNSELING TREATMENT PLAN
Treatment Plan Date
*
/
Month
/
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Client's Number:
*
Client's D.O.B:
*
-
Month
-
Day
Year
Date
Counselor's Name:
*
Counselor's Email:
*
example@example.com
Plan to Coordinate Services:
Problem/Symptom:
*
Long Term Goal:
*
Involvement of Family:
*
Services needed beyond the scope of the organization/program:
*
Anticipated Completion Date
/
Month
/
Day
Year
Date
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1. Short Term Goals/Objective:
*
1. Date Established:
-
Month
-
Day
Year
Date
Projected Completion Date
*
-
Month
-
Day
Year
Date
Date Achieved:
-
Month
-
Day
Year
Date
2. Short Term Goals/Objective:
*
2. Date Established:
-
Month
-
Day
Year
Date
Projected Completion Date
*
-
Month
-
Day
Year
Date
Date Achieved:
-
Month
-
Day
Year
Date
3. Short Term Goals/Objective:
*
3. Date Established:
-
Month
-
Day
Year
Date
Projected Completion Date
*
-
Month
-
Day
Year
Date
Date Achieved:
-
Month
-
Day
Year
Date
4. Short Term Goals/Objective:
4. Date Established:
-
Month
-
Day
Year
Date
Projected Completion Date
-
Month
-
Day
Year
Date
Date Achieved:
-
Month
-
Day
Year
Date
5. Short Term Goals/Objective:
5. Date Established:
-
Month
-
Day
Year
Date
Projected Completion Date
-
Month
-
Day
Year
Date
Date Achieved:
-
Month
-
Day
Year
Date
Intervention/Action:
*
Responsible Person's Signature
*
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Date
/
Month
/
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
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