Consultation Group

Case Consultation Peer Review Form

Name:__________________________________________ Date: _____________________

Case Consultation Session number: _____________________________________________

Presenter and film/character: __________________________________________________

Facilitator: _________________________________________________________________

Identifying data about the client (age, gender/gender identity, marital status, employment, education, living situation, social support, or other data relevant to the case):

Presenting problem:

Consultation Questions:

Responses:

Rationale:

At least three things the presenter did well:

1. _____________________________________

2. _____________________________________

3. _____________________________________

The next time the presenter delivers a case, they could improve by:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

The facilitator helped the case consultation process by:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________