Case Report Form

Copy this form and type your answers to these questions, then upload your answers to the student portal.

Observation Video Title: 

Date watched: 

Counselor’s Name: 

Session #:

Session Length:

1. Significant background information.
2. Summary of reasons they came for counseling (presentation problem).
3. What changes were made by the counselee since last session (as a result of applying last session’s counsel and performing last session’s homework)?
4. What main problems were discussed in this session?
5. What unbiblical habits of thinking and /or behaving are you seeing in the counselee (preconditioning)?
6. What idols and/or heart issues are emerging? (“I must _________”)
7. What Biblical solutions were presented in this session (tie in with #4)?
8. What homework was given and how did it specifically apply to the problems (tie in with #4)?
9. If someone asked the counselee right after the session, “What did you learn that you needed to change,” what would you want him to say?
10. How was hope or encouragement given in this session?
11. How is the overall counseling process progressing? What issues have been sufficiently addressed by you and changed by the counselee?
12. What are your goals for future sessions?