Information and Consent – Clinical Supervision
Supervision is a professional relationship with its own obligations. Yet it’s easy for it to run on an informal email and good intentions. When questions come up about confidentiality, recordings, telehealth or a late cancellation, there’s often nothing in writing to point to.
This form gives your practice a clear, structured starting point for every supervisory relationship. It records the supervisee’s details and sets out how sessions run, how information is handled and what happens when plans change. Expectations are agreed before the first session, not negotiated after a problem.
What’s covered:
- Personal, contact and emergency contact details, with inclusive options for title, pronouns and gender identity
- Referral source and newsletter consent
- How to contact the practice, and clear limits on supervisor availability in emergencies
- Telehealth arrangements, including platform security, confirming the supervisee’s location, restrictions on recording, and how long the supervisor waits for log-in
- Privacy and confidentiality, including the limits to confidentiality and guidance for supervisees involved in ongoing court matters
- Responsible use of AI tools
- CCTV use, storage and disposal
- Fees, deposits, cancellations and missed appointments
- Consent and signature section
- Instructions for use, with three ways to implement it: practice management software, an existing template, or a fillable PDF
- A version control table for review and approval
The form is written to support compliance with the Australian Privacy Principles, the AHPRA Code of Conduct (2025 release), the APS Code of Ethics and the APS Private Practice Management Standards. Bracketed fields make it simple to add your own fees, systems and contact details. The result is a professional, transparent foundation for supervision that protects both supervisor and supervisee.
