Fake name, age, grade, and school, to disguise the clients identity.

Referral Problem.

Background Information

Family history.
School history.
Behavioral history.
Developmental/health history.
Course of Counseling

State your goals for counseling.

Summarize the progression of counseling sessions.

Describe techniques you used and your reason for using them.

Give an overview of the process using the Egan or a similar model.

Outcome

Describe the outcome of counseling – Was the client improved and how did you know.
Relate this to the goals you stated above.
State the reason for terminating.
If the case is still in progress, simply state that.