Get the free Supervision Professional Disclosure Statement

Licensed Professional Counselor in North Carolina Professional Disclosure Statement Danielle L.A. Brown, MA, LPC, NCC Eclectic Therapeutic Connections, LLC Office: 9196374089 Crisis #: 9193228236

How to fill out supervision professional disclosure statement

How to fill out a supervision professional disclosure statement:

1. Begin by including your name, contact information, and professional credentials at the top of the document. This information should be easily visible and accessible to anyone reviewing the statement.
2. Clearly state the purpose of the disclosure statement. Explain that it is a document outlining your professional qualifications, experience, and any relevant policies or procedures that may affect your supervision practice.
3. Provide a brief overview of your background and experience in the field of supervision. This may include details about your education, training, and any certifications or licenses you hold.
4. Outline your approach to supervision. Describe the theories or models you use, as well as any specific techniques or strategies that are important to your practice. It is essential to provide transparency and clarity about your supervisory style.
5. Include information about your availability and scheduling. Specify when and how often you are available for supervision sessions, as well as how you prefer to be contacted by supervisees.
6. Detail the fees and payment policies associated with your supervision services. Include the hourly rate or package fees, as well as any policies regarding missed or canceled sessions and payment methods accepted.
7. Mention any relevant ethical guidelines or codes of conduct that you follow. This may include adherence to professional standards and maintaining confidentiality with supervisees.
8. Include information about the termination or transfer of supervision services. Explain the process for concluding supervision relationships and any policies regarding transferring supervision to another professional.
9. Provide a place for both parties to sign and date the disclosure statement. This signifies that both the supervisor and supervisee have read and understood the contents of the document.
10. Finally, make sure to review and update the disclosure statement regularly to reflect any changes in your professional practice, policies, fees, or other relevant information.

Who needs a supervision professional disclosure statement?

1. Individuals who are providing supervision to other professionals in their field, such as clinical supervisors, educators, or mentors, should have a supervision professional disclosure statement. This document ensures clarity, professionalism, and accountability in the supervisory relationship.
2. Supervisors who are seeking licensure or certification in the field of supervision may be required to submit a supervision professional disclosure statement as part of their application process. It demonstrates their qualifications and commitment to ethical and professional supervision practices.
3. Supervisees who are engaging in a formal supervision relationship should review the supervision professional disclosure statement provided by their supervisor. This document allows supervisees to understand the supervisor's qualifications, expectations, and policies, ensuring a more informed and effective supervisory experience.

For pdfFiller’s FAQs

What is supervision professional disclosure statement?

The supervision professional disclosure statement is a document that outlines the supervisor's qualifications, experience, and policies for supervision.

Who is required to file supervision professional disclosure statement?

Supervisors who are providing clinical supervision to supervisees are required to file the supervision professional disclosure statement.

How to fill out supervision professional disclosure statement?

The supervision professional disclosure statement can be filled out by providing detailed information about the supervisor's credentials, experience, supervision style, and policies.

What is the purpose of supervision professional disclosure statement?

The purpose of the supervision professional disclosure statement is to inform supervisees about the supervisor's qualifications, experience, and supervision policies.

What information must be reported on supervision professional disclosure statement?

The supervision professional disclosure statement must include information about the supervisor's qualifications, experience, supervision style, policies, and any potential conflicts of interest.

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