Therapy Supervision Registration Form

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Name *
Age *
Gender *
Preferred pronouns *
Email Id *
Currently Residing in *
Phone Number *
I am ( select one) *
Required
Supervisor you wish to consult *
Education *
Qualifications and Previous training in therapy (Write None if none) *
What is the purpose of supervision for you? *
Which school of therapy do you follow? *
What are your expectations from supervision? *
Which method of supervision are you seeking? *
How did you get to know about us? *
By submitting this form, I consent to supervision and will maintain the client’s confidentiality.
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