My Treatment Plan
Name
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Date
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Problem #
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My counselor and I agree that the problem/goal I need to work on is:
We have identified the following as a strength I have that can help me work on this problem/goal.
Strength
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Goal
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Date Added
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Steps to Complete Goal
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Completion Target Date
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Date Completed
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1.
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2.
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3.
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4.
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5.
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Intervention(s)
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Participant’s Signature: _______________________________________________ Date: ___________________
Counselor Signature: __________________________________________________ Date: ____________________
Reviewed:______________ Date:______________ Reviewed:______________ Date: ______________
Reviewed:______________ Date:______________ Reviewed:______________ Date: ______________