Client and SW Agreement

The agreement is between ___Client’s Name______ and  ___Social Worker Name_, who is practicing with TWCC TORONTO.

The purpose of goal of this agreement is to ______________________________________________________________________________________________________________________________________________________________

In order to achieve this purpose or reach this goal, the following objectives must be met:

1. ______________________________________________ (by date) _______________
2. ______________________________________________(by date)________________
3. _____________________________________________ (by date)________________

In order to reach these objectives, __(client’s name)____is to perform or engage in the following tasks or activities during or before the dates shown:

1. _______________________________________________(by date) _______________
2. _______________________________________________(by date) ______________
3. _______________________________________________(by date) _______________

In order to reach these objectives, _____(SW)____________ is to perform or engage in the following tasks or activities during or before the dates shown:

1. _______________________________________________(by date) _______________
2. _______________________________________________(by date) _______________
3. _______________________________________________(by date) _______________

Progress toward the objectives will be reviewed and evaluated by the means of the following procedures or methods:

______________________________________________________________________________________________________________________________________________________________

The consequences, if any, of not reaching the objectives of the following:

______________________________________________________________________________________________________________________________________________________________

The following steps or actions are required to renegotiate terms of the agreement:

______________________________________________________________________________________________________________________________________________________________

Signed__________________________________  Date: ______________________________

Signed __________________________________ Date: ______________________________