Initial intake and mental health screening, treatment plan and therapy agreement, session notes (SOAP), progress reviews, and termination summaries for psychology counseling practices and licensed therapists
Get started with PocperA summary of our work together as we close this chapter of therapy. We honour the gains, name what is still unfolding, and set up a sturdy plan for what comes next — including how to reach back to us when that feels right.
Client name:
Total sessions:
Treatment period (e.g. "Mar 2024 – May 2026"):
Termination date:
If other or there is helpful context, please describe:
What brought you in initially:
A summary of the work — themes explored, modalities used, turning points:
Coping skills, insights, behavioral changes, and relational growth:
What is still unfolding — areas where continued attention may be helpful:
Early warning signs to notice — physical, emotional, behavioral:
Coping toolkit — what has worked best for you:
Support people you can lean on:
Daily and weekly self-care commitments:
A reminder of supports for difficult moments — local crisis lines, a trusted person to contact, and the nearest emergency department. Please write down what you would want a future-you to remember.
Psychiatrist / medication provider:
Group therapy or workshop:
Peer support program:
Community resources (local services, helplines, advocacy groups):
Apps, books, podcasts, online communities that may support continued growth:
Optional — what stands out from our work together, what you want to remember, what you might say to a future-you:
Therapist's observations on growth, key moments, and what stands out:
Ending therapy is not goodbye forever. The door stays open in the ways below — please tick those that match our agreement.
I consent to a 6-month follow-up check-in
Client signature:
Therapist signature:
Date signed:
I have reviewed this summary and agree it reflects our work together
Thank you for trusting this work. The skills and insights you have built belong to you now — carry them forward gently, and reach back when it serves you.
The Termination Summary & Follow-Up Plan template is a ready-to-use form from Pocper's Psychology Counseling Practice pack. Customize the fields to match your workflow, then share a link so clients can complete it and upload documents in real time.