Private Practice Forms
Save yourself the time and money required to create your own supervision forms from scratch! Private Practice Forms for Clinical Supervisors includes 3 attorney-reviewed, ready-to-adapt forms (totaling 11 pages) and have been updated for 2023. These forms will provide a basis for building clear agreements with supervisees regarding your services and will also serve as an important part of your administrative record-keeping.
The following forms are included:
• Informed Consent and Contract for Clinical Supervision: provides the supervisee with relevant information about clinical supervision services and obtains their consent for receiving these services; includes sections on supervisor’s background and scope of practice, “what to expect,” online supervision, confidentiality issues, and policies regarding appointments, communication, and payment.
• Supervisee Questionnaire: provides the supervisor with the supervisee’s identifying information, background, employment, progress towards licensure, and clinical supervision needs.
• Informed Nature and Limits of Collaborative Supervision Processes: informs the supervisee and their site supervisor of nature and limits of providing clinical supervision to supervisees employed in agencies or other settings with existing supervisory structures.
These are the forms that I use in my own practice. The information contained in these forms reflect Oregon state laws and rules, the American Counseling Association Code of Ethics, and the needs of my own supervisees and practice. You’ll need to modify forms in this packet so that they are in compliance with your own state laws and rules and professional organization’s codes of ethics and guidelines, and to reflect the needs of your own supervisees and your own practice. Sections that most clearly need modification have been highlighted.
Ordering Information and Refund Policy
Private Practice Forms for Clinical Supervisors is available as a single Microsoft Word document (for Windows or Mac) and is delivered by digital download. Once your purchase has been approved, you’ll receive a confirmation e-mail that contains the link you need to download this document. To prevent unauthorized distribution, sharing, or transferring of this product, this link is accessible only once. Once you’ve modified the forms, you can print hard copies or PDF versions of individual forms directly from the Microsoft Word file, and/or copy them into the forms section of your EHR. Because the forms are delivered by digital download, I’m unable to offer refunds, but please do get in touch if I can help you with your order in any way.
Lastly, purchasing these forms grants you access to a private Facebook group for additional support from Ryan and other practitioners in private practice. The link for joining this group will be included in your order confirmation e-mail.