PSYCHOTHERAPY NOTES FORM

PSYCHOTHERAPY NOTES FORM
7603 Georgia Ave NW, Suite 305, Washington, DC 20012 * Phone: 202-779-8424* Email: Vicky@goodnessisgood.net
Information:
Therapist Name
Client Name
Client ID
Session Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Session Number
1. Observations (Behavior, Mood, Affect)
2. Content of the Session (Themes, Issues, Discussed) (Note: Avoid listing specific interventions or medications here)
3. Clinical Impressions (Hypotheses, Reactions, Associations)
4. Transference/Countertransference Noted
5. Therapist Reflections/Plans for Next Session
Confidential Psychotherapy Notes-Not to be included in the client's official medical or billing record.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

1. Observations (Behavior, Mood, Affect)