MENTAL HEALTH TREATMENT PLAN
Client Name:	Client DOB:	Creation Date:	5/12/22
Diagnosis I:
Diagnosis II:
Diagnosis III:
Rendering Provider(s):	Adam J. Freitag, LCSW
Session Focus:	Individual	Couples/Marriage	Family	Other (specify):
Treatment Goals
Issue I:	Expected End Date
Goal I (qualitative):
Task Ia (quantitative):
Task Ib (quantitative):
Issue II:	Expected End Date
Goal II (qualitative):
Task IIa (quantitative):
Task IIb (quantitative):
Issue III:	Expected End Date
Goal III (qualitative):
Task IIIa (quantitative):
Task IIIb (quantitative):
Issue IV:	Expected End Date
Goal IV (qualitative):
Task IVa (quantitative):
Task IVb (quantitative):
Issue V:	Expected End Date
Goal V (qualitative):
Task Va (quantitative):
Task Vb (quantitative):
Other Information
Signatures
Therapist:	Printed Name:	Adam J. Freitag, LCSW	Date:
Therapist:	Printed Name:	Date:
Client:	Printed Name:	Date:
Client:	Printed Name:	Date:
Client:	Printed Name:	Date:
Client:	Printed Name:	Date: