Clinical Forms CD

New mental health practitioners or those transitioning to private practice face the daunting task of developing an entire array of clinical forms. We have available, on CD-Rom in Microsoft Word format, 15 of the most commonly requested forms developed and used at CounselingWorks. The forms include:

Adult Psychosocial History
Child Psychosocial History
Treatment Plan Template
Treatment Plan Safety Plan Addendum
Clinical Progress Note
Informed Consent For Treatment
Itemized Account Ledger
Demographic Data Sheet
Consent to Release Information
Release of Information Cover Letter
Reduced Fee Agreement
Missed Appointment Letter
Service Termination Letter
Notice of Privacy Practices

This is a wonderful collection of clinical and administrative forms, including the HIPAA-required Notice of Privacy Practice, for only $75. You may purchase the CD with personal check or credit card. Simply call the office at 727-967-3320 with your payment preference and address.

Supervision Forms CDs

These are forms and materials we have developed at CounselingWorks for use in Clinical Supervision of Registered Clinical Social Work and Mental Health Counselor Interns. All forms are in Microsoft Word format and can be easily customized to meet your specific needs.

The following items are available:  

Supervision CD "A" includes 14 forms:  

  1. Registered Intern Applicant Interview Guide
  2. Registered Intern Application/Face Sheet
  3. Prospective Intern Reference Letter
  4. Applicant Acceptance and Instruction Letter
  5. Contract for Clinical Supervision Services
  6. Letter to Board of Clinical Social Work Affirming Initiation of Supervision Services
  7. Letter to Board of Clinical Social Work Affirming Termination of Supervision Services
  8. Case-based Clinical Review Form (for use in conjunction with the DSM Case Book)
  9. Case Presentation Form
  10. Clinical Supervision Progress Note for Individual Supervision Sessions
  11. Clinical Supervision Progress Note for Group Supervision Sessions
  12. Sample Supervision Plan
  13. Sample Weekly Written Summary/Sample Weekly Written Journal
  14. Sample Treatment Plan Objectives

Supervision CD "B" includes the 14 forms listed above, PLUS 9 additional forms for use with interns who are seeing private clients within the supervisor's practice. These forms are:  

  1. Initial Client Contact Screening Form
  2. Informed Consent for Counseling Services with a Registered Intern
  3. Release of Information to Clinical Supervisor
  4. Notice of Privacy Practices Acknowledgement of Receipt
  5. Client Progress Note
  6. Sample Completed Progress Note
  7. Sample Narrative Treatment Summary
  8. Client Satisfaction Survey
  9. Chart Audit form

 Flash Cards

This is an outstanding pack of 300 flashcards, designed for use in individual and group supervision, or intern self-study, in preparation for the clinical licensing exam. Primary areas of focus include: DSM; Theories and Theorists; Medications; Definitions; and Research Design.

Some sample questions are below (answers can be found at the bottom of this page):  

  1. An individual expresses strong homophobic statements but then is found to be engaging in an illicit gay affair. His public statements best illustrate this defense mechanism.
  2. This diagnosis describes the intentional production of symptoms for the purpose of assuming the patient role.
  3. This is the most likely side effect of phenothiazines such as Thorazine.
  4. The essential feature of this disorder is a markedly disturbed and developmentally inappropriate social relatedness that begins before age five and is associated with grossly pathological care.
  5. This schematic diagram of a family system includes at least three generations.

PRICE LIST:

Clinical Forms CD (15 forms)  
Supervision CD "A"(14 forms) 
Supervision CD "B"(23 forms) 
Flashcards (300 cards)   

$75
$100
$125
$75

To order:
We accept personal or company checks, money orders and all major credit cards. You may arrange for payment as follows:

MAIL: CounselingWorks, P.A. 6710 Embassy Blvd., Suite 202, Port Richey FL 34668
PHONE: 727-967-3320 (leave credit card information and address on our confidential voicemail)
FAX: 727-848-4795 (fax your credit card information and address on our confidential fax line)  

Credit card orders will be sent out within 24 hours via priority mail. Shipping is free! Personal checks will be held to clear before your order can be shipped.  

Flashcard answers:

  1. Reaction Formation
  2. Factitious Disorder
  3. Drowsiness
  4. Reactive Attachment Disorder
  5. Genogram