Request for Supervision
Please complete the request for supervision form below and Chris will contact you to begin the process.  The supervision process is as follows.

1. Reviewing of your current supervision needs
2. Scheduling of a 15 minute no charge consultation to assess for potential barriers, issues with supervision (This can be done virtually)
3. Signing of supervision informed consent
4. Submission of documents to board to begin supervision

Upon receipt of supervision documents by the board and the board approval for supervision, supervision will be scheduled.  For the first two months, the expectation is weekly supervision.  After two months, supervision can be dropped down to every other week if it is appropriate.
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Name *
Email address
Phone number
License type *
License number *
Type of supervision requested? *
Are you currently under supervision? *
I am aware of the cost of supervision, $90 for individuals, $40 for 2 or more participants per hour *
Current Workplace *
Describe the type of work you do and client base *
Contact Information for Employer *
Have you ever had your license limited by the board or had any kind of malpractice suit filed against your license? *
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