心理咨询记录表(6次咨询记录模板).doc

心理咨询记录表
咨询师：第 次咨询
姓名

性别

出生年月

学历

职业

家庭
住址

既往病史

联系
方式

咨询时间
年 月 日 时
来访者主诉：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________咨询要点记录：
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
本次咨询作业与下次咨询计划:
____________________________________________________________________________________________________________________________
咨询师签名: 年 月 日
心理咨询记录表
咨询师:第 次咨询
咨询记录：
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________本次咨询作业与下次咨询计划：
______________________________________________________________________________________________________________________________咨询师签名： 年 月 日
心理咨询记录表
咨询师：第 次咨询
咨询记录：
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________本次咨询作业与下次咨询计划：
______________________________________________________________________________________________________________________________咨询师签名: 年 月 日
心理咨询记录表
咨询师：第 次咨询
咨询记录：
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________
______________________________________________________________________________________________________________________________本次咨询作业与下次咨询计划：
______________________________________________________________________________________________________________________________咨询师签名： 年 月 日
心理咨询记录表
咨询师：第 次咨询
咨询记录：
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________
______________________________________________________________________________________________________________________________本次咨询作业与下次咨询计划：
______________________________________________________________________________________________________________________________咨询师签名： 年 月 日
心理咨询记录表
咨询师：第 次咨询
咨询记录：
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________
______________________________________________________________________________________________________________________________本次咨询作业与下次咨询计划：
______________________________________________________________________________________________________________________________咨询师签名： 年 月 日
心理咨询记录表
咨询师：第 次咨询
咨询记录：
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________
______________________________________________________________________________________________________________________________本次咨询作业与下次咨询计划：
______________________________________________________________________________________________________________________________咨询师签名： 年 月 日
心理咨询记录表
咨询师:第 次咨询
咨询记录：
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________
______________________________________________________________________________________________________________________________本次咨询作业与下次咨询计划：
______________________________________________________________________________________________________________________________咨询师签名： 年 月 日