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Peer Supervision Form
Greetings from Room, The Mindcare Space!
Thank you for expressing your interest! Please fill in your details to register with us.
Details:
Frequency
: 2 hours, once a week.
Fees:
Rs. 708/session (Inclusive of GST).
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* Indicates required question
Full Name
*
Your answer
Contact details
*
WhatsApp number and email
Your answer
Age
*
Your answer
Sex and Pronouns
*
Your answer
Name of last graduating college
*
Your answer
Name of current organisation / Practice
*
Your answer
Qualifications
*
Your answer
Preferred Psychological School of Approach
*
Eclectic is of course the norm, but preferences/comfortable approaches are expected
Existential Psychotherapy
Humanistic Psychotherapy
Psychodynamic Psychotherapy
Other:
Required
Are you taking therapy for yourself?
*
Yes
No
Experience with Number of clients
*
Your answer
Have you taken supervision before
*
Yes
No
If yes, with whom and reason for change?
Your answer
Preferred mode of Supervision
*
Online
In person (For ahmedabad residents)
Frequent or common challenges faced in the sessions with every client
*
Your answer
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