LFS Treatment Plan Update Form

Date

Completed By:*

ClientParent/GuardianTherapistOther

Therapist Name:*

First NameLast Name

Client Name:*

First NameLast Name

Individual Goals and/or Objectives:*

Family Goals and/or Objectives*

Do you feel that you've made progress on previous Goals/Objectives?*

YesNo

Client achieved _______ of previous Goals/Objectives*

1-25%26-50%51-75%76-100%

Do you feel that you would benefit from continuing with current Goals/Objectives?*

YesNo

Client Strengths: *

Client Abilities:*

Client Gains Achieved:*

New Needs:*

New Problems:*

Change in Type of Services:*

YesNo

If Yes, explain:

Change in Frequency of Services:*

YesNo

If Yes, explain:

Did you discuss Discharge criteria?*

YesNo

Discharge Criteria:

Estimated Discharge Date and Aftercare:

Do feel that services are based on your preferences and your goals?*

YesNo

If No, what are your preferences?

Summary of last 6 months:

Signature

Please enter your (clinician) email address:*

A copy of this form will be sent to this email address.

Please re-enter your (clinician) email address for verification:*

Reenter your email address exactly as it was typed in the email address field to verify that it’s correct. If you get a message indicating the two fields don’t match, double-check what was typed in each field.