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Supervision Interest Application
Thank you so much for your interest in having Jen Haefele, RDN, CDN, CEDS-S provide professional supervision.
Please fill out the following form and we will be in touch soon.
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Email
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Your email
Name (First and Last)
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Your answer
Phone Number
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Your answer
Organization (company, private practice, etc.)
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Your answer
How did you hear about supervision with Jennifer Haefele?
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Instagram/Facebook
Provider (Therapist, Physician, Psychiatrist, etc.)
Recommendation from friend, family, neighbor, etc.
13WHAM/News
Google
Higher level of care recommendation
Other:
If it was a provider or a higher level of care please list here.
Your answer
Please describe what led you to seek supervision:
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Your answer
Estimated number of times per month you would like to meet (supervision is offered in one hour increments)
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Your answer
Virtual or In-Person
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Your answer
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