PlayWell with Dr. Erica

Supervision Interest Form

Thank you for your interest in supervision. Please complete this form in full before reaching out directly. This helps ensure we're the right fit for each other.

Before you fill this out: PlayWell supervision is not for everyone, and that's okay. I work with clinicians who are serious about their credentialing and professional growth, committed to culturally responsive practice, and ready to do the deeper work that supervision requires. If that's you, let's talk. This form replaces the initial inquiry email.

First name

Last name

Email

Number

State Where You Practice

License Type

License Number

WHAT TYPE OF SUPERVISION OR CONSULTATIONS ARE YOU SEEKING?

Clinical licensure supervision (toward LCSW, LPC, LMFT, etc.)

Play therapy supervision (toward RPT credential)

Consultation only (already credentialed, seeking case/clinical consultation)

I'm not sure — I need help figuring out what I need

IF SEEKING RPT SUPERVISION WHERE ARE YOU IN THE RPT PROCESS?

Just starting- I have completed or am completing the required play therapy coursework

In progress- I am actively accumulating my direct and supervisory hours

Almost there- I have most of my hours and am close to applying

I'm still exploring whether the RPT credential is right for me

If seeking play therapy supervision, which phase best describes where you are?

N/A — I am not seeking play therapy supervision

Phase 1 — Building the foundation: learning play therapy theory, setting up the playroom, beginning to use directive and non-directive techniques

Phase 2 — Developing competence: applying theories consistently, increasing comfort with the process, tracking themes and metaphors in sessions

Phase 3 — Integration and identity: developing a clear theoretical orientation, working with complex presentations, beginning to feel like a play therapist

I'm not sure what phase I'm in

Approximate Direct Hours Completed

Approximate Supervised Hours Completed

Your Practice & Clientele

Primary Practice Setting

If "Other" or still developing, briefly describe:

What You're Looking For

Why PlayWell? Why Dr. Erica specifically?

What are your top 2–3 supervision goals right now?

What type of supervision are you seeking?

Individual supervision (1:1)

Group supervision

Open to either / both

Preferred supervision format

In person (Scottsdale, AZ area)

Telehealth / virtual

Hybrid — open to either

Fit & Readiness

Describe your previous supervision experience.

Which of the following best describes your readiness?

I am ready to begin supervision immediately and have funding in place

I will be ready within the next 1–3 months

I am still exploring my options and not yet ready to commit

Are you able to self-pay for supervision, or are you seeking scholarship/sliding scale?

I can self-pay at the standard rate

My employer covers supervision costs

I am interested in the PlayWell Equity Pipeline Scholarship

I need to discuss sliding scale options

General availability for supervision sessions

Anything Else

Is there anything else you'd like me to know before we connect?

How did you hear about PlayWell with Dr. Erica?

By submitting this form, you acknowledge that completing it does not guarantee placement in supervision, nor does it constitute a supervisory relationship. Dr. Erica will review all submissions and reach out only to candidates who appear to be a strong fit. Submitting this form is not an emergency resource- if you are in crisis, please contact the 988 Suicide & Crisis Lifeline or your local emergency services.

I have read and understand the above statement, and I confirm that all information provided is accurate

PlayWell Supervision Interest

Supervision Interest Form

What You're Looking For

Stay in the know, subscribe below