Counseling Session Discharge Form
Please fill out this form to complete your discharge process from counseling sessions.
Full Name
*
First Name
Last Name
Date of Discharge
*
-
Month
-
Day
Year
Date
Counselor's Name
*
First Name
Last Name
Summary of Counseling Sessions
*
Reason for Discharge
*
Please Select
Completed Treatment
Personal Choice
Referral to Another Provider
Other
Additional Comments
*
Signature
*
Submit
Should be Empty: