Counseling Goals

Name:

Date of Birth:

Date:

GOALS ARE VERY IMPORTANT IN THERAPY!

Goals provide the client and the therapist with a focus and a direction for therapy sessions. Please briefly list the goals that you want to address and reach in counseling.

For adults and/or minors (adult guardians would answer for minors):

1:

2:

3:

What qualities have helped you to succeed at overcoming difficulties or reaching goals in the past?

1:

2:

3:

Please tell us about your plans for the future (educational, career, personal, etc.)

1:

2:

3:

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What concerns do you have about therapy or working on these problems/areas of growth?

1:

2:

3:

What qualities have helped you to succeed at overcoming difficulties or reaching goals in the past?

1:

2:

3:

Please tell us about your plans for the future (educational, career, personal, etc.)

1:

2:

3:

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Psychotherapy Appointment Policy

I understand that I have reserved a regular psychotherapy time for a particular day, time and frequency, and agree that if I am unable to come in for my regularly scheduled appointment, I will provide as much notice as possible, with a minimum 24-hour notice.

I understand that psychotherapy appointments missed without notice, will be assigned a $100 charge. I understand that missed appointments cannot be filed with my insurance, and that I will be solely responsible for these charges.

I understand that multiple missed appointment and/or failure to cover balances in a timely manner may result in the closing of my therapy chart.

Patient Name

Name of Responsible Party (if not the patient)

Signature of Responsible Party/Patient

Date

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Statesboro Psychiatric Associates

Psychotherapy Registration

Counseling Goals

GOALS ARE VERY IMPORTANT IN THERAPY!

Psychotherapy Appointment Policy

Submit Form