Session Notes First Name * Last Name * Date * Time in * 121234567891011 : 00153045 AMPM Time out * 121234567891011 : 00153045 AMPM Total time of session (hours: minutes) * 15 minutes30 minutes45 minutes1 hour1.25 hours1.5 hours1.75 hours2 hours2.25 hours2.5 hours2.75 hours3 hours3.25 hours3.5 hours3.75 hours4 hours4.25 hours4.5 hours4.75 hours5 hours People present during session * Client’s response to treatment * PositiveNeutralNegative Did the parents/guardians participate in the session? * YesNo Programs/ Goals parent’s participated in Checkboxes * Differential Reinforcement Positive Reinforcement Shaping Chaining Task Analysis FCT Visual Schedules Activity Schedules Self-monitoring Client’s condition upon arrival * No sign of illness upon arrival Fatique Fever Flu-like symptoms Cold/ runny nose allergies OtherOther Address where session took place * Address where session took place Address where session took place Address where session took place City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Session Narrative * Session Data Program 1 Program 2 Program 3 Date of next session * reCAPTCHA Therapist Name * type your name Signature If you are human, leave this field blank. Submit