Pre-Supervision Questionnaire

Thank you for your interest in our supervision services. We have developed the following questionnaire to help us connect you with the supervisor that might best meet your needs. The questions are completely optional. Take as much time or space as you like to answer the questions to the extent that it feels comfortable. We look forward to meeting you!

All the best, Lisa Pearl, Heather Bell, Jennifer Locke, and Nicole Patience

Name

Phone

I am seeking (check one or both)

Supervision of my professional practice

Supervision of my supervision

Is this part of your iaedp credentialing?

How long have you worked with individuals struggling with eating disorders or body image?

Tell us a little about yourself (just briefly is fine!) and your work….

What would you most like to get out of supervision? This can be the big picture, specific areas, or small things. It might be case consultation, professional support, or a creative space for reflection.

Do you have any learning goals? For example, this might include counseling skills, boundaries, team communication and collaboration, and self-awareness. Or this may involve specific topics such as working with ambivalence, session structure, or co-morbidities. We will continue to visit these issues as we work together, but it helps to know if you have something in mind as we get started.

Is there anything else that feels like it might be helpful for us to know or understand?

How often are you interested in meeting?

What are the best times/days for you to meet?

If you are human, leave this field blank.