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College of Social Sciences Master of Science in Counseling

Treatment Plan

Client Name:       Date:      

Clinical Placement Student:      

Type of service (check one): FORMCHECKBOX Individual FORMCHECKBOX Family FORMCHECKBOX Child FORMCHECKBOX Couple

1. Target Problem      

Specific/Short Term Goals:

     

Objectives:

Strategies/Interventions to Achieve Goals:

2. Target Problem

Specific/Short Term Goals:

Objectives:

Strategies/Interventions to Achieve Goals:

Monthly Review date: ___________________________________      

Client Signature: _______________________________________ Date:      

Counseling Student Signature: ____________________________ Date:      

Supervisor Signature: ___________________________________ Date: