| Client name____________________ | Date__________ |
| We want to encourage our clients throughout their treatment and supervision episode. Please help us by identifying items that would serve as incentives to motivate you to make continued progress toward positive life goals. | |
| What is your: | |
| Favorite snack?____________________ | |
| Favorite soda or juice?____________________ | |
| Favorite candy bar?____________________ | |
| Favorite sports team?____________________ | |
| Favorite clothing store?____________________ | |
| Favorite restaurant?____________________ | |
| Which grocery store do you prefer? | |
| _____Giant | |
| _____Safeway | |
| _____Super-fresh | |
| _____Shoppers | |
| _____Other:____________________ | |
| Which drug store do you prefer? | |
| _____CVS | |
| _____Walgreens | |
| _____Rite Aid | |
| Which variety store do you prefer? | |
| _____Walmart | |
| _____K-Mart | |
| _____Target | |
| Which fast food restaurant do you prefer? | |
| _____McDonalds | |
| _____Wendy's | |
| _____KFC | |
| _____Burger King | |
| _____Taco Bell | |
| _____Other:____________________ | |
| Where would you like to go? (check those that apply) | |
| _____Science Center | |
| _____Aquarium | |
| _____ESPN Zone | |
| _____Baltimore Zoo | |
| _____Reginald Lewis Museum | |
| _____National Great Blacks in Wax Museum | |
| _____Movie theater | |
| _____Restaurant (Which restaurant?____________________) | |
| _____Other:____________________ | |
