Client Goals

Location

Our mission is to assist you, our client, in achieving good mental health and improving your overall functioning. So that we may monitor your progress as you work though our issues, please answer the following questions by choosing the answer that described how you are functioning today. Thank you.

I feel better more days than I feel bad

This does not apply to me
This is mostly NOT true
This is somewhat true
This is more often true
This is extremely true

I am obtaining my education

This does not apply to me
This is mostly NOT true
This is somewhat true
This is more often true
This is extremely true

I have been able to maintain my employment

This does not apply to me
This is mostly NOT true
This is somewhat true
This is more often true
This is extremely true

I socialize and relate well with my family and friends

This does not apply to me
This is mostly NOT true
This is somewhat true
This is more often true
This is extremely true

I follow my medication regimen

This does not apply to me
This is mostly NOT true
This is somewhat true
This is more often true
This is extremely true

If you answered "Mostly NOT true" to any question above, what would you like to work on?

Client Name

Date