Treatment Progress Assessment Questionnaire
Use this form to review treatment progress, track current status, and note follow-up needs. Keep the title exactly as shown: Treatment Progress Assessment Questionnaire.
Treatment Context
Treatment name or service
*
Treatment start date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current treatment phase or stage
*
Initial
Active
Maintenance
Follow-up
Completed
Other
Primary goal being monitored
*
Progress Assessment
Overall progress since last check-in
*
No progress
1
2
3
4
5
6
7
8
9
Excellent progress
10
1 is No progress, 10 is Excellent progress
Symptoms or outcome change since last check-in
*
Improved
Unchanged
Worsened
Mixed
Unsure
Adherence to treatment plan
*
1
2
3
4
5
Treatment indicators
Rows
Current Status
Change Over Time
Pain level
1
2
Energy level
3
4
Sleep quality
5
6
Daily functioning
7
8
Follow-up Notes
Current concerns or side effects
Preferred follow-up action or next review focus
Medication review
Symptom monitoring
Treatment adjustment
Lifestyle guidance
Further testing
Other
Additional comments
Submit Treatment Progress Assessment Questionnaire
Should be Empty: