This form is for therapists who are assessing clients who have applied for subsidy. What issue is the client bringing? I.e. What behaviour are they struggling with? What is the client's goal? How motivated do you think the client is? Low 1 2 3 4 5 6 7 8 9 10 High Are there things that might get in the way of therapy working? (for example issues with non prescription drugs, alcohol etc) What is the likelihood of 6 sessions (or 12 sessions) enabling the client to make the changes he is asking for Low 1 2 3 4 5 6 7 8 9 10 High Do you think that a subsidy would be a good use of StopSo's money? Is there anything else you think we should know?