Supervision and Consultation Interest Form

Supervision and Consultation Interest Form
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
What kind of supervision/consultation are you looking for?

Supervision for LPC/LSW LicenseesGeneral Clinical ConsultationLGBTQIA2S+ Specific Consultation (including WPATH and Gender Affirming Letter Writing)Group Practice/Private Practice Owner Consultation
Please describe the specifics of what you are hoping to accomplish in supervision.
Please describe the specifics of what you are hoping to accomplish in clinical consultation.
Please describe the specifics of what you are hoping to accomplish in EMDR consultation.
Please describe the specifics of what you are hoping to accomplish in LGBTQIA2S+ specific consultation.
Please describe the specifics of what you are hoping to accomplish in practice owner consultation.
Supervision for LPC/LSW Licensees is provided by the following supervisors. Please click their names to view their bios.

April Cunningham, LPCC-S

Julie Hazel, LPCC-S

Alexis Rae Burrow, LPCC-S

Jess Homan, LISW-S
General Clinical Consultation is provided by the following supervisors. Please click their names to view their bios.

April Cunningham, LPCC-S

Julie Hazel, LPCC-S

Alexis Rae Burrow, LPCC-S

Jess Homan, LISW-S
LGBTQIA2S+ Specific Consultation is provided by the following supervisors. Please click their names to view their bios.

Julie Hazel, LPCC-S

Jess Homan, LISW-S
Group Practice/Private Practice Owner Consultation is provided by the following supervisors. Please click their names to view their bios.

Abbey Carter Logan, LPCC-S

Emily Clark, LPCC-S
Please select which provider you would prefer to work with, if applicable.

April Cunningham, LPCC-SAlexis Rae Burrow, LPCC-SJulie Hazel, LPCC-SJess Homan, LISW-SNo Preference
Please select which provider you would prefer to work with, if applicable.

Alexis Rae Burrow, LPCC-S
Please select which provider you would prefer to work with, if applicable.

Julie Hazel, LPCC-SJess Homan, LISW-SNo Preference
Please select which provider you would prefer to work with, if applicable.

Abbey Carter Logan, LPCC-SEmily Clark, LPCC-SNo Preference
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