Goals for Service Planning (Adult)
Please select the clinician from the card given to you by the front desk:
1. What are your reasons for coming to Bridges Healthcare, Inc.?
2. How have the above caused problems in your life?
3. Do you need help with other concern/problems or have any special needs or accommodations? (These may include assistance with walking, vision, hearing, and/or reading.)
4. What are your expectations for your child/family members during the assessment and initial treatment?
5. What do you hope to gain from coming to Bridges or being in therapy? How can we assist you in reaching your hopes, dreams, preferences, etc.?
6. How will you know when your goals are met (that is, when you would be ready to decrease your sessions or stop therapy altogether)?
7. Name of Primary Care Physician:
Address of Primary Care Physician:
Street Address Line 2
State / Province
Postal / Zip Code
Phone Number of Primary Care Physician:
8. Name of Emergency Contact:
Relationship to you:
Phone Number of Emergency Contact:
9. What times (day of week, morning, afternoon, evening) are you available for your appointments?
Should be Empty: