Case Consultation Consultant Interest Form

Thank you for your interest in joining us as a monthly consultant for our team’s case consultations. These are not supervision sessions; rather, they are opportunities for our team to review cases and gain insights from your expertise.

Format: Virtual, once per month

Duration: 1 hour

Rate: $150 per session (fixed)

About us: Our clinicians are EMDR trained and practice using a somatic and collaborative framework with their clients.

Please complete the form below so we can keep your information on file.

Name

First Name

Last Name

Email

Phone

(###)

###

####

Professional License/Credentials

Specialties/Areas of Focus

Availability

Morning (9–12 PST)

Afternoon (12–4 PST)

Evening (4–7 PST)

Please indicate the months you would be available to provide our small team with case consultation per your specialty? (Jan-Dec)

Have you facilitated case consultations before?

Yes

No

What are your social media handles?

I understand that these consultations are not supervision and will be paid at a fixed rate of $150 per 1-hour session.

I agree