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Therapist Consultation Form
Therapist Consultation Form
Appointment Id:
Client Name:
Status of the session
Yes, it happened
No show
Rescheduled
Cancelled
Did the session start and end on time?
Yes to both
No to both
Started on time, extended time
Started late, ended on time
What are the client's presenting concerns (Top 3)?
What is the prelimnary action plan for next few sessions? concerns
Based on the session, how likely are they to come to therapy?
No mostly
Maybe no
Maybe
Maybe yes
Mostly yes
Please mention the barrier that you see
What is the followup session date you have recommended them?
Do you recommend diagnostic test?
Yes
No
Which test do you recommend?
Depression
Anxiety
Attachment
OCD
Would you recommend Therapy packages to them ?
Yes
No
Which one would you recommend ?
1 Session
3 Session
5 Sessions