Client Information and Consent Couples Therapy

Client Information and Consent Couples Therapy V2

BACKGROUND INFORMATION:

PRESENTING CONCERNS:

TREATMENT HISTORY:

MEDICAL INFORMATION:

MEDICAL CONDITION:

PAST MEDICAL HISTORY:

MENTAL HEALTH HISTORY:

THERAPY HISTORY:

GOALS FOR THERAPY:

SECOND PERSON

BACKGROUND INFORMATION:

PRESENTING CONCERNS:

TREATMENT HISTORY:

MEDICAL INFORMATION:

MEDICAL CONDITION:

PAST MEDICAL HISTORY:

MENTAL HEALTH HISTORY:

THERAPY HISTORY:

GOALS FOR THERAPY:

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