Request for Supervision with Kelly L Charles LCSW
Thank you for your interest in clinical supervision! I offer virtual supervision for LCWAs in NC and CSWAs in Oregon. Please complete the form below to help me understand your needs and determine fit. You’ll receive a follow-up email within 2–3 business days.  If you do not receive a response please reach out to the office via email at intake@savvywellnesscenter.org or via phone at 866-736-6408.
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Email *
Full Name *
Phone Number
Are you currently a associate licensed? *
How long have you been associate licensed? *
Are you currently receiving supervision? *
What kind of supervision are you seeking? *
Required
Briefly describe your current role or clinical setting. *
Preferred days/times for supervision (e.g. weekday evenings, Saturdays, etc.) *
What clinical areas or goals would you like to focus on in supervision? 
What is your anticipated budget per session? *
Is there anything else you would like for me to know?
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