Family Therapy Termination Form
Please complete this form to document the conclusion of family therapy sessions in a clinically appropriate manner.
Family/Client Name
*
Therapist Name
*
Date of Termination
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Termination
*
Please Select
Treatment goals met
Client/family decision
Therapist recommendation
Non-attendance
Referral to other provider
Other
Summary of Treatment Progress
*
Discharge Recommendations
*
Follow-up or Referral Needs
Any Remaining Concerns
Date of Initial Session
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Total Number of Sessions Attended
Submit
Should be Empty: