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* 1. Your name

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* 2. Your email address and telephone number(s)

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* 3. What is your approach?

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* 4. Stage in your career & professional bodies

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* 5. Briefly outline the experience you have of group supervision and what you are looking for in this group supervision.

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* 6. What other (if any) sources of supervision do you have? For example do you have individual supervision and how frequently?

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* 7. What would be your preference for group supervision?

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* 8. Please tick in order of preference all the times you are available for regular supervision

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* 9. If you cannot make any of the times above please give an idea of your availability.

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* 10. How did you hear about us?

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