Counseling Services

Date:

First Name:

Last Name:

Partner if applicable:

Marital Status:

Email:

Phone Number:

Write the name of your PO if applicable :

Who was the Provider?:

Overall Impression:

What did you learn from today's topic?:

What would you change about yourself as a result of today’s topic?:

List your families generational substance abuse or domestic violence patterns:

How has the 2ove1, LLC classes/sessions helped you, your family. marriage and/or work?:

Next Session Date and Time:

Fecha:

Nombre:

Apellidos:

Nombre de la pareja, si corresponde

Email:

Número de Teléfono:

Nombre del instructor:

Impresión General:

¿Que aprendiste del tema hoy?:

¿Qué cambiarías de ti mismo como resultado del tema de hoy?:

Liste los patrones generacionales de abuso de sustancias o violencia doméstica de su familia:

¿Qué areas de mejoramiento personal has visto desde tu ultima clase?:

Próxima sesión (fecha y hora)

Date:

First Name:

Last Name:

Email:

Partner Name if applicable:

Marital Status:

Phone Number:

Who was the Provider?:

Overall Impression:

Who is willing to participate in your family treatment ?, list their names:

List your biggest struggles right now?:

What expectations and desired outcomes do you have for yourself?:

How can you take what you learned from today’s lesson and apply it to your situation at home or work?  :

Next Session Date and Time:

Date:

First Name:

Last Name:

Email:

Partner Name if applicable:

Marital Status:

Phone Number:

Who was the Provider?:

Overall Impression:

How can you take what you learned from today’s lesson and apply it to your situation at home or work?

What is your biggest struggle right now?:

Explain the changes you see in yourself:

What goals have you set for yourself and what will help you meet these goals? :

Next Session Date and Time:

Explain if there are changes in your family support? :

Date:

First Name:

Last Name:

Email:

Partner Name if applicable:

Marital Status:

Phone Number:

Who was the Provider?:

Overall Impression:

Explain what changes, if any you have made in your marriage, with your family or with your children:

Explain what behaviors do you need to change if any to help you and why:

What things are you implementing or doing to have a stable, habitable, drug & alcohol free residence?:

List the family obstacles or generational patterns you have identified :

Explain what you have learned in treatment/2love1:

Next Session Date and Time:

Date:

First Name:

Last Name:

Email:

Partner Name if applicable:

Marital Status:

Phone Number:

Who was the Provider?:

Overall Impression:

List your biggest accomplishments or what are you most proud of? :

Explain what goals you have set for you and your family:

How do your values differ from your friends and family?:

What life experiences led you to your current values & beliefs? :

How can you take what you learned from today’s lesson and apply it to your situation at home or work?:

Next Session Date and Time:

Date:

First Name:

Last Name:

Email:

Partner Name if applicable:

Marital Status:

Phone Number:

Who was the Provider?:

Overall Impression:

What have you learned in treatment to help with situations that will impair your recovery? :

How are you keeping your home stable, habitable and drug and alcohol free?:

What character flaws have you changed as a result of what you have learned at 2love1?:

What goals are you currently working on to maintain lifelong sobriety and avoid criminal activity? :

Explain what you learned in your session today in your own words:

Next Session Date and Time: