Assessing supervision needs form

Thanks for considering The Provisional Psychologist Network to support you in your journey towards registration or endorsement.

This form has been completed to get the most information from you that will support us determining whether Annie Slater is the right fit to support your supervision needs. The more detail you provide, the better we can understand how Annie’s experience aligns with your needs.

If you’ve already decided that you’d like to work with Annie, we still ask that you complete the form so we can confirm she has the appropriate professional experience to support your specific requirements. Your responses will only be reviewed by Annie and the administrative team and will remain confidential. If there is anything you like to share not in written form please contact us on 0447332708.

If you don’t yet have a role, there’s no need to complete this form. Just reach out once you do. This is because your supervision needs will depend on the nature of your role and what you need supervision support with, and we want to ensure Annie is the right fit to support you.

PROCESS FOR PRIMARY SUPERVISION

1. You complete this brief form
2. The Provisional Psychologist Network will then review the details to determine whether Annie is a suitable match
3. If appropriate, we will offer you a no-fee 15-minute consultation with Annie, so you can ask questions and decide whether you’d like to proceed
4. You then let us know if you would like to move forward
5. We’ll then send you a welcome pack and supervision contract, and you can book in a session to complete your paperwork and get started

PROCESS FOR SECONDARY SUPERVISION

1. Complete this brief form
2. The Provisional Psychologist Network will then review the details to determine whether Annie is able to support you in a secondary supervision capacity.
3. If suitable, we will confirm this with you and proceed
4. You can then send any required paperwork for Annie to sign, or we can send you a pre-signed secondary letter template to add Annie to your internship plan
5. We’ll then send you a welcome pack and supervision contract
6. You can then book sessions as needed

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Location*

Role & Responsibilities (which age groups, across the lifespan etc):*

Are you going to be working in positive behaviour support (NDIS)?*

Hours contracted to work per week?*

Internship pathway you are seeking to complete?*

If registrar, which endorsement?

What supervision support are you requiring? Secondary? Primary? Registered? Group Supervision? Case Report Review? *

Have you already commenced an internship program? If so how many hours and which tasks have you completed? *

Availability for supervision? Add any constraints you have*

Previous work experience and qualifications*

Therapies trained in*

What are you looking for in a supervisor?*

Any specific interests?

Our supervisors only provide sessions online via zoom or via telephone. Is this ok with you?*

YesNo

Anything else relevant you would like to share?

Where did you hear about us?*