TERMINATION SUMMARY



Counseling Center State University of New York at Buffalo

120 Richmond Quadrangle (716) 645-2720

Buffalo, NY 14261-0019

Case # V

TERMINATION SUMMARY

Client: Date:

Number of Sessions: Duration of Therapy: to

Number of Missed Sessions:

Intake Date: Termination: Planned or Unplanned (delete one option)

Identifying Data and Presenting Problem:

Major Issues:

1.

Summary of Treatment:

(Include information related to content of sessions, client dynamics/process, progress of therapy, goal accomplishment, therapeutic relationship, and therapeutic interventions)

Status at Termination/Recommendations for Future Treatment:

__________________________ __________________________

Counselor Signature Supervisor Signature

Title Title

(if applicable)

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