Youth Counseling Session Report Form
Use this form to document a youth counseling session, including the youth’s needs, session focus, counselor observations, safety review, and follow-up plan.
Session Details
Counselor / Clinician Name
*
First Name
Last Name
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Session Start Time
Hour Minutes
AM
PM
AM/PM Option
Session End Time
Hour Minutes
AM
PM
AM/PM Option
Session Type
*
Please Select
Individual
Group
Family
Follow-up
Intake
Crisis
Other
Specify Other Session Type
Session Location / Method
*
Please Select
In-person
Phone
Video
School
Community Site
Other
Specify Other Location / Method
Referral Source
Youth / Client Information
Youth / Client Name
*
First Name
Last Name
Preferred Name (if different)
Age
Pronouns
Please Select
She/Her
He/Him
They/Them
Other
Grade / School / Program Affiliation
Guardian / Contact Person Name and Relationship
Presenting Concerns and Session Focus
Presenting concerns
*
Primary session focus/topic
*
School stress
Family conflict
Peer relationships
Anxiety
Mood
Behavior
Attendance
Grief/loss
Safety
Other
Goals addressed today
Coping skills
Communication
Emotional regulation
Attendance support
Behavior support
Safety planning
Problem-solving
Other
Brief summary of the discussion
Counselor Observations and Progress
Counselor observations of mood, affect, and engagement
*
Low
Mildly low
Neutral
Mildly positive
Positive
Highly engaged
Progress toward goals since last session
*
1
2
3
4
5
Strengths observed
Interventions/strategies used in session
*
Active listening
Coping skills practice
CBT exercise
Grounding
Safety planning
Psychoeducation
Problem-solving
Role-play
Other
Youth response to interventions
Risk and Safety Review
Current safety concerns identified
*
Yes
No
If yes, type of concern
Self-harm thoughts
Suicidal thoughts
Harm from others
Harm to others
Abuse/neglect concern
Runaway concern
Substance-related concern
Other
Immediate actions taken
Protective factors
Supportive family or caregiver
Trusted adult or mentor
School connection
Peer support
Engagement in counseling
Future goals or plans
Religious or spiritual support
Other
Safety plan follow-up needed
*
Yes
No
Plan and Follow-Up
Next Steps
*
Referrals / Resources Provided
None
Crisis Hotline
Community Support Group
School Counselor
Medical Referral
Parenting Resource
Housing Support
Food Assistance
Other
Homework / Coping Practice Assigned
Follow-Up Appointment Date/Time
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Preferred Follow-Up Timeframe
Counselor / Internal Sign-Off Name
Submit Report
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