( Required fields are marked with * )
NHS Trust or Employer Name: *
NHS Trust or Employer Invoice Address: *
Country & Postal Code *
Your name: *
Your title:
Your phone number: *
Your email: *
NOTE: The invoice will be sent to this email
Name, Email and Phone Number of a backup contact in your office:
Are you a NHS Trust? *
Is Child Trauma Therapy Centre already an approved vendor for your Trust?
Upload or email the Vendor Application
Please put PO# in the email subject line.
Supervision request details:
The cost of individual and group supervision is £130 for a 55-minute hour.
Are you aiming to purchase individual or group supervision? *
How many therapists will be needing individual supervision? *
How many individual, 1-hour supervision sessions are you requesting for each therapist? *
Please provide the names, email addresses, and phone numbers of all the therapists you know will be getting individual supervison: *
How many supervision groups will you need? *
Group 1
What unique name would you like to give to Group 1?
Are you the Lead Therapist for this group?
If NO then who is?
How many therapists will be in Group 1? *
How long would you like the Group 1 sessions to be? *
How many supervision sessions are you requesting for Group 1? *
Please provide the names, email addresses, and phone numbers of all the therapists you know will be participating in the Group 1 supervison: *
Group 2
What unique name would you like to give to Group 2?
Are you the Lead Therapist for this group?
If NO then who is?
How many therapists will be in Group 2? *
How long would you like the Group 2 sessions to be? *
How many supervision sessions are you requesting for Group 2? *
Please provide the names, email addresses, and phone numbers of all the therapists you know will be participating in the Group 2 supervison: *
Group Totals
Totals:
Are you located in England, Northern Ireland, Scotland or Wales? *
Total number of therapists:
Total number of supervision hours:
Total cost of supervision:
Do you have a Purchase Order (PO) Number? *
It’s best if you can provide a PO at this step. But if you need an invoice to generate a PO, we will email you one when you submit this form. After we get your PO, we will email you an amended invoice. Supervision will be delayed until payment is received.
Enter the PO number here: *
Upload or email the Purchase Order document:
Please put PO# in the email subject line.
Enter any comments for us here:
After you submit this, we'll send you an invoice at the email you provided. If you do not receive an invoice within 2 business days, please contact us.
After your invoice is paid, we’ll email you prepaid Coupon Codes to give your therapists. They can use these codes to book their supervision. Please note: Coupon Codes expire one year after issue date.
