Atlanta, GA USA

(404) 985-6785

Live Chat: 8 - 6 pm EST

Sample Clinical Supervision Contract


Sample Clinical Supervision Contract – Free Download

This sample clinical supervision contract is free and customizable. Much of this sample clinical supervision pdf download is based on understanding your role as a supervisor or your role as a supervisee.

So where do you begin? Thankfully, I’ve done a lot of the work for you. Here are key elements that should be included in a clinical supervision contract.  I also offer a comprehensive ethics workshop on supervision documentation.

How is Clinical Supervision for LPC in Georgia defined?

First, the definition of LPC supervision varies widely from state to state. The definition of Supervisor in Georgia Composite board rules are, ” …direct clinical review, for the purposes of teaching…purpose of supervision is to promote the development of the practitioner’s clinical skills.” The paragraph also discusses what types of direct clinical review are acceptable. Read the full definition here at 135-05-.01 “Definitions”, paragraph 4. Please note the policies change without notice.

Important Board Policies

Georgia’s Composite Board has also implemented several policies not included in board rules that are important to read and understand. More detail of supervisor/supervisee responsibilities can be found directly on the APC forms.

5 Basics of a Solid Clinical Supervision Contract

The document will open in a new browser window. Continue reading below. Some supervisors choose to include other key elements in supervision in the contract such as their various models and approaches to clinical supervision.

General Agreement

The agreement should convey confidence, competence and decisiveness. It should be direct. Finally, it should convey a supportive supervisory relationship and importantly, a relationship of mutual trust. First, this sample clinical supervision contract addresses:1) The professional responsibilities of the supervisee.2) The respective professional roles of supervisor and supervisee.

Board Law and Rules

1) The supervisee must thoroughly understand board rules including diagnose and testing rules.2) The supervisor will assist with understanding GA composite board rules in all manners possible.3) Finally, the honus is on the supervisee to know the board rules.

Specific Tasks Required in Clinical Supervision

1) Evaluation2) Supervisor Intervention. In addition, supervisors should seek ethics ce training in managing boundaries with supervisees/ students. 3) Duty to warn.


This section does not address notes and documentation of supervision, but important documents you will want to have in their file. 1) Malpractice Insurance2) A complete copy of the APC application.3) Supervisee forms previously submitted with their LAPC/APC license application. 4) The application for supervision. Prior to what you can expect in the supervision interview, you will want the supervisee to complete a specially designed application for supervision.

Termination of Supervision

Note the sample clinical supervision contract also includes how supervision can be terminated.

Writing a Killer Supervision Contract

A good example of a clinical supervision contract should make clear respective roles. For example, it is the supervisee’s job to be teachable. In addition, the supervisor should make clear the supervisee’s responsibilities for maintaining their license. Third, the supervisor should have a clear understanding of the supervisee’s past and current work and supervision experience. And finally, how to avoid financial disputes with the supervisee.

You deserve a former licensing board president on your side.

More Stories

FREE supervision contract template