Therapist Evaluation and Goal Setting Form
Complete this form to assess client needs and collaboratively set therapy goals.
Presenting Concerns (select the most relevant)
*
Anxiety
Depression
Stress
Relationship Issues
Trauma
Other
How would you rate the severity of your main concern?
*
1
2
3
4
5
Duration of current concern
*
Less than 1 month
1-6 months
6-12 months
More than 1 year
Current symptoms checklist (check all that apply)
Sleep difficulties
Appetite changes
Low energy
Difficulty concentrating
Irritability
Social withdrawal
Other
Rate your current functioning in the following areas:
*
Rows
Not at all
Slightly
Moderately
Very
Extremely
Work/School
1
2
3
4
5
Social Relationships
6
7
8
9
10
Self-Care
11
12
13
14
15
Daily Activities
16
17
18
19
20
Briefly describe any strengths or coping strategies you use:
Barriers to progress (select all that apply)
Motivation
Support system
Time constraints
Financial stress
Other
What are your primary goals for therapy?
*
How motivated do you feel to work toward your goals?
*
Not motivated
1
2
3
4
5
6
7
8
9
Highly motivated
10
1 is Not motivated, 10 is Highly motivated
Preferred approach for therapy
Solution-focused
Cognitive-behavioral
Mindfulness-based
No preference
Other
Submit Evaluation
Should be Empty: