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* 1. Client Name:

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* 2. Date:

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* 3. What could you do less of?

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* 4. What could you do more of?

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* 5. What could you stop doing?

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* 6. What could you continue doing?

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* 7. What could you start doing?

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* 8. Actions:

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* 9. Client is comfortable for action?

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* 10. Next appt:

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