Therapy Termination Worksheet
Complete this worksheet to summarize the end of therapy, review progress, and outline plans for moving forward.
Client Initials
*
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Therapist Name
*
Reason for Termination
*
Goals Met
Mutual Agreement
Client Decision
Therapist Recommendation
External Circumstances
Other
Summary of Progress
*
Status of Therapy Goals
*
All goals achieved
Most goals achieved
Some goals achieved
Goals not achieved
Not applicable
Any Ongoing Concerns?
Next Steps or Recommendations
*
Referrals or Additional Resources Provided
Final Notes
Submit Worksheet
Should be Empty: