RISTIANCOUNSELING

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JC CHRISTIAN COUNSELING~1821 Oregon Pike, Suite 212, Lancaster, PA 17601Phone: (717) 278-8326, FAX: 1-866-285-7198

ON-LINE CARE PLAN

Client's name:

Date of birth:

Date of appointment:

Time:

Location: .

Primary concern/problem:

Secondary concerns:

Primary diagnosis (if applicable):

Secondary diagnosis (if applicable):

1.) Goal:

Objectives:

Witness Signature:

Client Signature:

~) ----------------------------------------------------------------------b.) _

c.) _

II.) Goal:

Objectives:

a.) _

b.) _

c.) _

III.) Goal:

Objectives:

a.) _

b.) _

c.) _

I, , have assisted in the creation and development of my care plan. These are thegoals and objectives that I want to accomplish for myself

I recognize that the goals and objectives can and may change throughout the timeframe of my therapy, either by accomplishingmy goal or deciding that certain goals are no longer a goal in which I choose to achieve, at which during that time, the counselorand I will make an addendum to the current care plan.

Client Signature

(For adolescents) Adult Accountability Signature

Witness Signature

Review Date: Review Date:

Client Signature:

Witness Signature:

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