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Session Report

Please fill out the session report below for the current pay period.

Clinician:

Pay period (1-15 or 16-end of month)

Total Scheduled Sessions

Total Sessions Held

Total Missed Sessions

Please describe the child's participation, performance, attitude, attendance, etc.

Please describe the child's behavior.

Please choose any concerns you have about the child.

She/he is often sad

She/he is often worried

She/he is often upset

She/he is often tearful or cries

She/he does not have many friends

She/he often gets in trouble

She/he is disrespectful of teammates

She/he is disrespectful of authority figures

She/he is often tired

She/he is often hungry when others aren't

She/he is quick to anger

She/he often appears dirty

She/he is often absent

She/he is often late

She/he rarely comes prepared

She/he has trouble focusing or staying on task

She/he has trouble sharing

She/he often has conflict with others

She/he hurts others

She/he often lies

She/he often steals

She/he reports abuse at home

She/he would rather be alone

She/he bullies others

She/he is often bullied by others

She/he often seems afraid

She/he lacks confidence

She/he struggles with social skills

She/he struggles with grasping concepts

She/he might have ADHD

She/he often has unexplained bruises

She/he frustrates easily

She/he often complains of headaches, stomach pain, or illness

She/he seems fearful of mom

She/he seems fearful of dad

None of these

Other:

Email

oaksfamilycounseling@gmail.com

Call or Text

352 871-2080

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