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Counseling Case Notes - Google Forms

The document contains a counseling case notes form that collects information such as the student's name, grade, teacher, date and time of meeting, referral source, reason for meeting, notes from the session, and plans for future counseling. The form is used to document counseling sessions for students and gather relevant details about the meetings.

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404 views3 pages

Counseling Case Notes - Google Forms

The document contains a counseling case notes form that collects information such as the student's name, grade, teacher, date and time of meeting, referral source, reason for meeting, notes from the session, and plans for future counseling. The form is used to document counseling sessions for students and gather relevant details about the meetings.

Uploaded by

api-542228297
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Counseling Case Notes

* Required

1. Student's Name *

2. Grade Level *

Mark only one oval.

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

3. Student's teacher *

4. Date *

Example: January 7, 2019

5. Time *

Example: 8:30 AM
6. Referral Source *

Mark only one oval.

Teacher/Staff

Principal

Parent/Guardian

Student

Other:

7. Reason for meeting (check all that apply) *

Check all that apply.

Check-in
Just visiting
Friendship/Peer issue
Needed break from class
Sadness
Anger
Anxiety/Worry
Family concern
Lunch
Group
Behavior concern
Academic concern
Other:

8. Notes from Session *


9. Discuss future counseling plan if needed

This content is neither created nor endorsed by Google.

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