Client 4 digit ID number: |
|
| |
|
| Date of Meeting |
|
| |
|
Place of Meeting |
IHoH office Other:
|
|
|
Behavior Description: |
Cooperative,
Distant,
Legalistic,
Uncooperative,
Docile |
|
Other, Describe
|
|
|
Participation: |
Attentive,
Talkative,
Positive,
Negative,
Reluctant,
Counterproductive |
|
Other, Describe
|
|
|
Rapport with |
Friendly,
Polite,
Noncompliant,
Lackadaisical, |
lay counselor: |
Other, Describe
|
|
|
Resistance: |
Guarded,
Resentful,
Domineering,
Rude,
Obnoxious,
Threatening |
|
Other, Describe
|
|
|
Topics Discussed: |
|
|
Summary and Recommendations: |
|
|
|
|
|
Next Meeting: |
|
Client prayer request: |
|
|
|
Counselor ID number |
|
|
|
|
|
|
|
thank you |