Individual Supervision — Consultation Request

Contact Information

First name

Last name

Email address

Phone

Province

Professional Background

Registration / designation

Years in practice

Practice setting

Organization

Supervision Goals

Primary reason for seeking supervision

What are you hoping to get from supervision?

Do you have specific client populations or modalities you want to focus on?

Scheduling & Availability

Preferred session cadence

General availability for consultation calls

Mornings (before 12 PM)

Afternoons (12–5 PM)

Evenings (after 5 PM)

One Last Thing

How did you hear about Cecilia or Eterna?

I understand that submitting this form does not establish a supervisory relationship. Cecilia will be in touch to confirm fit and availability before any agreement is made.

Individual Supervision — Consultation Request