Counseling Completion Certification
Please fill out the details to certify the completion of counseling sessions.
Client Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Counseling Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Counseling End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of Sessions Completed
*
Counselor's Name
*
First Name
Last Name
Certification Statement
*
Counselor Signature
*
Submit
Should be Empty: