what is a healthy food log

University of South Carolina

Counselor Education Program

Wellness Intervention Plan

Date: Client: Client DOB: _______

Concerns	Goals/Objectives	Interventions

I have discussed the plan above with my counselor, understand the recommended strategies, and agree to participate as an active member in my plan.

Client: _________________________________ Date:

Client Signature: _________________________________ Date:

Counselor Signature: _________________________________ Date:

Supervisor Signature: _________________________________ Date:

Original

Revised