Collaborative Treatment/Goal Plan & Treatment/Goal Plan Update Form
At Oceanside Family Therapy & Assessments we encourage the client to be an active participant in his or her own treatment planning and goal setting. After all, these are your goals for yourself.
Periodically, we will ask you to complete this short treatment/goal planning form and at any time you wish to make changes you can request to update your Treatment/Goal Plan. Once you complete it just hit submit or if you prefer it can be done with your therapist during your next session.
For minors, this form may be completed by the child or the parent (depending on age) or a collaboration of both.
This document is confidential and intended only for use between this clinician and the client, as provided by Florida law and HIPPA.
If any of the required fields are not relevant to you, enter n/a or none.
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Email *
 Today's date: *
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YYYY
Client's full name: *
Client's date of birth: *
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YYYY
How satisfied are you with your current functioning? *
Not very
Very much
Have you ever been diagnosed with a mental health diagnosis? If so, please list below: (n/a if none or please describe) *
Are you currently taking any psychotropic medication? If so, please list: *
How much is your diagnosis or are your current problems impacting your life, negatively? *
Not very
Very much
What is your number one goal for talk therapy (or coaching)? (Think measurable, achievable in a 3-6 month period, this can be re-assessed later, for example, "I want to set healthier boundaries with_____") *
How would you notice if you were making progress towards this goal, what would be different? *
What is your number two goal for talk therapy (or coaching)? (Think measurable, achievable in a 3-6 month period, this can be re-assessed later, for example, "I want to reduce my gaming/drinking/binge eating to_____") *
How would you notice if you were making progress towards this goal, what would be different? *
What is your number three goal for talk therapy (or coaching)? (Think measurable, achievable in a 3-6 month period, this can be re-assessed later, for example, "I want to be assessed for ADHD and have a better understanding of my symptoms and how they impact me.") *
How would you notice if you were making progress towards this goal, what would be different? *
What modalities do you prefer to help you meet your goals? Check all that apply: *
Required
How currently satisfied are you with these areas of functioning in your life? *
1 = Very dissatisfied   5 = Very satisfied
1
2
3
4
5
N/A
Academics or Occupation
Social/Friends
Interpersonal Communication
Sleep Quality
Exercise and activity
Diet/Eating Well
Hobbies/Activities
Personally/Thoughts etc.
Family
Community (church, groups, neighbors, etc.)
Additional information not captured above:
How often would you like to engage in talk therapy (or coaching)?
Both teletherapy and in person
Any additional comments regarding the sessions or overall goals?
Electronic Signature (print name) of client/patient. For minors, please indicate parent signature, relationship to the child and the child's name. *
This Treatment/Goal Plan form was completed by: *
Required
This Treatment Plan is a collaboration between the client/patient and the clinician, Nicole Story, EDS, MED, LMHC, LMFT who herby certifies that this Treatment Plan is clinically reviewed and tailored to meet the best needs of the client/patient throughout the course of treatment.
𝒩𝒾𝒸𝑜𝓁𝑒 𝒮𝓉𝑜𝓇𝓎, 𝐸𝒟𝒮, 𝑀𝐸𝒟, 𝐿𝑀𝐻𝒞, 𝐿𝑀𝐹𝒯, 𝚀𝚂-𝙵𝙻
____________________________________________________

Psychotherapist, Clinical Director
Oceanside Family Therapy & Assessments
𝘈𝘵 𝘖𝘤𝘦𝘢𝘯𝘴𝘪𝘥𝘦 𝘍𝘢𝘮𝘪𝘭𝘺 𝘛𝘩𝘦𝘳𝘢𝘱𝘺 𝘢𝘯𝘥 𝘈𝘴𝘴𝘦𝘴𝘴𝘮𝘦𝘯𝘵𝘴 𝘸𝘦 𝘤𝘢𝘳𝘦 𝘢𝘣𝘰𝘶𝘵 𝘱𝘳𝘰𝘵𝘦𝘤𝘵𝘪𝘯𝘨 𝘵𝘩𝘦 𝘤𝘰𝘯𝘧𝘪𝘥𝘦𝘯𝘵𝘪𝘢𝘭𝘪𝘵𝘺 𝘢𝘯𝘥 𝘤𝘰𝘯𝘵𝘳𝘰𝘭 𝘰𝘧 𝘗𝘦𝘳𝘴𝘰𝘯𝘢𝘭 𝘏𝘦𝘢𝘵𝘩 𝘐𝘯𝘧𝘰𝘳𝘮𝘢𝘵𝘪𝘰𝘯 𝘰𝘧 𝘰𝘶𝘳 𝘤𝘭𝘪𝘦𝘯𝘵𝘴 𝘢𝘯𝘥 𝘥𝘰 𝘯𝘰𝘵 𝘴𝘩𝘢𝘳𝘦 𝘸𝘪𝘵𝘩 𝘢𝘯𝘺 3𝘳𝘥 𝘱𝘢𝘳𝘵𝘺 𝘦𝘯𝘵𝘪𝘵𝘪𝘦𝘴, 𝘢𝘴 𝘢𝘭𝘭𝘰𝘸𝘦𝘥 𝘣𝘺 𝘍𝘭𝘰𝘳𝘪𝘥𝘢 𝘭𝘢𝘸 𝘢𝘯𝘥 𝘏𝘐𝘗𝘗𝘈. 𝘛𝘩𝘪𝘴 𝘦𝘭𝘦𝘤𝘵𝘳𝘰𝘯𝘪𝘤 𝘤𝘰𝘮𝘮𝘶𝘯𝘪𝘤𝘢𝘵𝘪𝘰𝘯 𝘪𝘴 𝘵𝘳𝘢𝘯𝘴𝘮𝘪𝘵𝘵𝘦𝘥 𝘪𝘯 𝘧𝘶𝘭𝘭 𝘤𝘰𝘮𝘱𝘭𝘪𝘢𝘯𝘤𝘦 𝘸𝘪𝘵𝘩 𝘖𝘤𝘦𝘢𝘯𝘴𝘪𝘥𝘦 𝘍𝘢𝘮𝘪𝘭𝘺 𝘛𝘩𝘦𝘳𝘢𝘱𝘺'𝘴 𝘦𝘭𝘦𝘤𝘵𝘳𝘰𝘯𝘪𝘤 𝘱𝘳𝘪𝘷𝘢𝘤𝘺 𝘢𝘯𝘥 𝘴𝘦𝘤𝘶𝘳𝘪𝘵𝘺 𝘱𝘰𝘭𝘪𝘤𝘺. 𝘛𝘩𝘦 𝘤𝘰𝘯𝘵𝘦𝘯𝘵 𝘰𝘧 𝘵𝘩𝘪𝘴 𝘧𝘰𝘳𝘮 𝘪𝘴 𝘤𝘰𝘯𝘧𝘪𝘥𝘦𝘯𝘵𝘪𝘢𝘭, 𝘢𝘯𝘥 𝘪𝘯𝘵𝘦𝘯𝘥𝘦𝘥 𝘧𝘰𝘳 𝘵𝘩𝘦 𝘴𝘱𝘦𝘤𝘪𝘧𝘪𝘦𝘥 𝘳𝘦𝘤𝘪𝘱𝘪𝘦𝘯𝘵 𝘰𝘯𝘭𝘺. 𝘖𝘤𝘦𝘢𝘯𝘴𝘪𝘥𝘦 𝘍𝘢𝘮𝘪𝘭𝘺 𝘛𝘩𝘦𝘳𝘢𝘱𝘺 𝘢𝘯𝘥 𝘈𝘴𝘴𝘦𝘴𝘴𝘮𝘦𝘯𝘵𝘴 𝘱𝘶𝘵𝘴 𝘵𝘩𝘦 𝘴𝘦𝘤𝘶𝘳𝘪𝘵𝘺 𝘰𝘧 𝘵𝘩𝘦 𝘤𝘭𝘪𝘦𝘯𝘵'𝘴 𝘪𝘯𝘧𝘰𝘳𝘮𝘢𝘵𝘪𝘰𝘯 𝘢𝘵 𝘢 𝘩𝘪𝘨𝘩 𝘱𝘳𝘪𝘰𝘳𝘪𝘵𝘺, 𝘵𝘩𝘦𝘳𝘦𝘧𝘰𝘳𝘦, 𝘸𝘦 𝘩𝘢𝘷𝘦 𝘱𝘶𝘵 𝘦𝘧𝘧𝘰𝘳𝘵𝘴 𝘪𝘯𝘵𝘰 𝘦𝘯𝘴𝘶𝘳𝘪𝘯𝘨 𝘢𝘭𝘭 𝘰𝘧 𝘰𝘶𝘳 𝘦𝘮𝘢𝘪𝘭 𝘮𝘦𝘴𝘴𝘢𝘨𝘦𝘴 𝘢𝘯𝘥 𝘎𝘰𝘰𝘨𝘭𝘦 𝘍𝘰𝘳𝘮𝘴 𝘢𝘳𝘦 𝘷𝘪𝘳𝘶𝘴 𝘧𝘳𝘦𝘦 𝘢𝘯𝘥 𝘦𝘯𝘤𝘳𝘺𝘱𝘵𝘦𝘥 𝘸𝘪𝘵𝘩 𝘢 𝘩𝘪𝘨𝘩 𝘭𝘦𝘷𝘦𝘭 𝘰𝘧 𝘴𝘦𝘤𝘶𝘳𝘪𝘵𝘺 𝘵𝘩𝘳𝘰𝘶𝘨𝘩 𝘵𝘩𝘦 𝘎𝘰𝘰𝘨𝘭𝘦 𝘞𝘰𝘳𝘬𝘴𝘱𝘢𝘤𝘦/𝘊𝘭𝘰𝘶𝘥 𝘐𝘥𝘦𝘯𝘵𝘪𝘵𝘺 𝘏𝘐𝘗𝘗𝘈 𝘉𝘈𝘈 (𝘣𝘶𝘴𝘪𝘯𝘦𝘴𝘴 𝘢𝘴𝘴𝘰𝘤𝘪𝘢𝘵𝘦 𝘢𝘨𝘳𝘦𝘦𝘮𝘦𝘯𝘵).
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