Progress Reporting Form
Today's Date
*
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Month
-
Day
Year
Date
Client Name
*
First Name
Last Name
Client Date of Birth
*
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Month
-
Day
Year
Date
Last Session Date
*
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Month
-
Day
Year
Date
Guardian Name
*
First Name
Last Name
Name of Worker
*
First Name
Last Name
Phone Number of Worker
*
Please enter a valid phone number.
Present Concerns / Symptoms
*
Current Goal
*
Progress
*
Regression
No Progress
Minimal Progress
Adequate Progress
Completed Goal
Details of Progress
*
Mental Health Symptoms
*
Depression
Anxiety
Mania
Hallucinations
Delusions
Suicidal Thoughts
Homicidal Thoughts
Impulsivity
Self-Injurious Behavior
Sleep Disturbance
Poor Concentration
Appetite Changes
Other
Details of Symptoms or Explanation of Other
*
Abuse or Safety Concerns (check all that apply)
*
No concerns reported
Suspected Abuse
Client Disclosed Abuse
Client at Risk of Harm to Self
Client at Risk of Harm to Others
Other
Date Mandated Report Filed (if applicable)
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Month
-
Day
Year
Date
Entity Mandated Report Filed With (if applicable)
Legal / School / Employment Issues (if any)
*
No issues reported
Involvement with Court
Probation / Parole
Truancy
School Suspensions / Expulsions
Job Loss / Conflicts
Other
Describe Other (if applicable)
Staff Comments / Plan for Next Steps
*
Submit
Should be Empty: