11/5/23, 2:12 PM
Bolton L COUC521 Benchmark Intake Report Part One Initial Interview Assi…
about:blank
1/6
1
Benchmark Intake Report Part One: Initial Interview Assignment
Lenny J. Bolton
Department of Counselor Education and Family Studies, Liberty University
COUC 521: Assessment Techniques in Counseling
Dr. Welch-Sigmon
January 23, 2022
c
11/5/23, 2:12 PM
Bolton L COUC521 Benchmark Intake Report Part One Initial Interview Assi…
about:blank
2/6
2
Benchmark Intake Report Part One: Initial Interview Assignment
Identifying Information
Client Name: Mark J. Wizer
Address: 1234 Westcare Way, San Diego, California 12345
Phone Number: 123-456-7890
DOB: 09/13/1985
Gender: Male
Marital Status: Single, never married
Occupation: Associate Pastor
Work/School: Associate Pastor at Hope Community Church/Bachelor of Science
in Psychology and Master of Divinity Student (about to finish his degree).
Work phone: 098-765-4321
Emergency Contact: Jennifer Wize, Sister, 123-456-8709
Date of Interview: 01/23/2022
Reason for Referral
