Child Therapy Termination Activities Form
Please complete this form to document and plan the termination activities for child therapy sessions.
Child's Full Name
*
First Name
Last Name
Date of Termination Session
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Therapist Name
*
First Name
Last Name
Session Type
*
Individual
Group
Family
Other
Termination Activities Planned
*
Review of progress
Discuss coping strategies
Provide resources
Farewell activity
Other
Were goals met?
*
All goals met
Some goals met
Goals not met
Aftercare or Referral Needed?
*
No further services needed
Referral to another provider
Community resources recommended
Other
If referral or aftercare recommended, please specify
Parent/Guardian Contact for Follow-up
Please enter a valid phone number.
Format: (000) 000-0000.
Closing Notes
Submit
Should be Empty: