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Survey Templates Health Care Surveys Clinical Supervision Survey Questions + Sample Questionnaire Template

Clinical Supervision Survey Questions + Sample Questionnaire Template

The clinical supervision survey is created to survey doctoral internship sites such as APA, COAMFTE and other such accredited programs. This in-depth survey template was created by industry leaders that have a holistic knowledge and understanding of doctoral internship programs. This survey has multiple questions that help collect demographic information about how the supervisor and supervisee for programs like clinical psychology, counseling psychology, rehab psychology, school psychology and family & marriage therapy. You can also use these survey questions to collect in-depth feedback about the supervision methods of a supervisor and the most effective steps and methods of developing an effective clinical supervision program.


Considering your complete experience with this clinical supervision program, how likely would you be to recommend us to a friend or colleague?
Very Unlikely
Very Likely
Please select the appropriate form to complete.

DEMOGRAPHICS
Highest Degree Earned:
Sex:
Age
Professional Credentials (licensed or certified):
Professional Membership:
Number of years practicing psychotherapy:
Number of years practicing supervision:
Theoretical Orientation:
Ethnicity:

Please provide as accurate a response as possible, recognizing that some responses will be approximations.
Courses in supervision
Textbooks read
Journal articles read
Workshops attended
Supervision cases while a practicum student
Supervision cases while an intern
Supervision cases since completing your degree
Hours of post-degree supervision-of-supervision (if known)

How formative were the following to your practice for supervision?

Please state your agreement with the below on the supervision you provide?


DEMOGRAPHICS
Highest Degree Earned:
Sex:
Age
Current program:
Current professional credentials (licensed or certified):
Is this your first supervised clinical experience?
If not, how many years of supervised practice have you completed?
Theoretical orientation:
Ethnicity:


Please provide as accurate answers as you can, realizing that some responses will be approximations.
Times per month
Hours per month
Times per month
Hours per month
How available is supervision outside of set supervision times?
What is the primary format for supervision?
What is your supervisor's theoretical orientation?

How descriptive are the following statements of your supervisor and the supervision you receive?
Is there any other feedback you would like to provide?

Thank you for taking the time to complete this survey! Your responses are anonymous and confidential.