Before you take the time to complete this form, please be aware that we do not provide supervision for the 4 + 2 pathway.

    First Name*


    Your pronouns (eg. she/he/they)


    Phone Number*

    How would you prefer to be contacted to discuss your initial booking?*

    Your current address*

    Street address



    How did you hear about Inner Melbourne Clinical Psychology?*

    Date of birth (day/month/year)*

    If you have a particular supervisor in mind, please note their name below

    If you don’t have a particular supervisor in mind, please take a look at our supervisor bios here. If after reading through these bios you’re not sure who might be a good fit for you, or your preferred supervisor isn't available, please fill out the questions below so that we can make some suggestions.

    What are your preferred days/times for appointments?

    What are the circumstances under which you are seeking supervision? You can select more than one.

    Please tell us more information about which study pathway you are undertaking as a provisional psychologist.

    What are your goals for supervision?

    How often do you intend to attend supervision?

    Do you have any preferences related to your supervisors’ style? For example, are you better suited to someone who is direct, gentle, structured or more fluid?

    What have you found helpful and unhelpful about supervision that you have received in the past?

    Is there anything else that you think it might be useful for us to know?