PANDA LEARNING PARTNERS, INC
Step Up Therapy Services
1100 Coney Island Ave, Suite 414; Brooklyn, NY 11230
Phone (718)434-1200; Fax (718)434-1099
SESSION NOTES
Childs’s Name______________________________________ DOB_________________ NYC ID #_____________________________
(LAST) (FIRST)
Weekly Mandate________________ Service Provided at ( ) Home, ( ) Other________________________________
Service Provider Name_________________________________________________________ Specialty__________________________
Date________________ Start Time_____________ End Time___________ Date Note Written_____________
If Make-Up Session: Check & Indicate Date of Session Missed ( ) Make-Up for______________
NOTE: Please indicate the date and reason for each missed session.
IEP GOALS: (What short term goals are you addressing?)
Lesson Development:
Parent/Caregiver Signature________________________________________ Relationship to Child____________________________
Service Provider Signature_____________________________________________
Date_______________ Start Time_____________ End Time_________________ Date Note Written________________________
(If Make-Up Session, Check & Indicate Date of Session Missed: ( ) Make-Up for_______________________
NOTE: Please indicate the date and reason for each missed session.
IEP GOALS: (What goals are you addressing?)
Lesson Development
Parent/Caregiver Signature_______________________________________ Relationship to Child_________________
Service Provider Signature________________________________________
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