Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Client Name *Therapist *--- Select Choice ---Amie NelsonEmily ConnellEmma MorganJaimi ThomasJeff SturgeonJordan BurnessJulie MageeKelsey BerntsonLaurie JanzenLucas SoNatasha ColeNedra HuffeyRebecca DuchesneauShannon ClarkSharon LeeSusan MorisonTamarah TernesTimena OsborneKartik RamanAiyman VassanjiSelect Third Party Agency *--- Select Choice ---Select Correct Agency to Generte Your SubmissionACORAYC ESS ProgramOther ESSIs this the First Session *YesNoTreatment Plan – First Session Only Counselling Goal (Brief, less than 20 words, usually can come from the YC Intake Form)Expected treatment frequency – days between sessions (Typically 14 days)Did the client report thoughts of suicide or any other safety concernNoYes – HighYes – ModerateYes – LowIf yes, describe risks and safety planSession Report Progress in resolving the problem (Select Slower than expected, Expected, Better than Expected, No Show / Late Cancel)Slower than expectedExpectedBetter than ExpectedNo Show / Late Cancel Session required interventions Clients involvement in resolving the problem (Select None, Minimal, Average, Fluctuating, Strong)NoneMinimalAverageFluctuatingStrongFactors interfering with the achievement of the objectives set out in the treatment plan (Not required but if relevant)Brief Summary of session theme and interventions (Ex. Used CBT modalities, Problem Solving, Sleep Hygiene. Briefly list the focus of the session, main topics discussed, briefly list the interventions. Max 500 characters. Omit details.)Submit Session Report
