POST-Parent Session Information

Name of Clinician Completing Parent Session/Completing This Form(Required)

First Last

Email of Clinician Completing Parent Session/Completing This Form(Required)

Enter Email Confirm Email

Name of Adolescent Clinician(Required)

First Last

Email of Adolescent Clinician(Required)

Enter Email Confirm Email

Parent Session Information

Client Name(Required)

First Last

Date of Initial Parent Session(Required)

Number of Parent Sessions for this Adolescent (including most recent)(Required)

Please enter a number from 1 to 100.

Date of Parent Session Being Reported Here(Required)

Name of Parent(s) Attending Last Session

Give a brief summary of the entire parent session.(Required)

What concerns or questions did the parents express? Be specific.(Required)

What specific goals or desires did the parents express?(Required)

What milestones, victories, or observed growth (in the adolescent) did the parents report? Be specific.(Required)

Generally, how did the parents report / you assess them feeling about therapy and progress thus far?(Required)

If the parents were mostly unhappy, please explain.(Required)

Postlude Information/Conclusions/Questions

Was there any information presented/discovered in this parent session that conflicts with information the adolescent has given? (For example, did the parents report the adolescent is still using substances but the adolescent is known to deny this?)(Required)

If there was conflicting information, please explain.(Required)

Based on your appraisal of both content and process in the Parent Session being evaluated here, what concerns or recommendations do you have for the adolescent therapist?(Required)

Anything not mentioned elsewhere on this form that you need or would like to convey about this parent session/adolescent?(Required)

What date did you schedule the next parent session for?(Required)

Was this an insurance-based client?(Required)

Prior to the next adolescent session, I would like to have a brief phone call with the adolescent therapist to discuss this client/the above.(Required)

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