Sample Notification Letter (of being under supervision)

December 12, 2013

Dear Ms. /Mr. Client,

This letter is to inform you that I will be receiving clinical supervision from Jim Kreider, LSCSW, who will provide oversight and guidance for my social work practice over the next two years.  He is a licensed clinical social worker who has been practicing here in Lawrence for the past 30 years: he has also taught social work practice at the University of Kansas for the past 20 years.

The clinical supervision I am receiving is part of an educational process that will increase my skills as well as allow me to become licensed at Kansas’ highest level, which is the LSCSW (licensed specialist clinical social worker).  I am currently licensed at the initial level, which is the LMSW (licensed master social work).

I will meet with Jim on a regular basis at which time I will share relevant case information with him about you and the services I am providing you. This will include information you have shared with me about your background, history, concerns, and goals that are related to assessment, evaluation, diagnosis, and treatment considerations.  He will use this information to advise me on providing the best clinical social work services for you that I can possibly do. 

Jim is ethically and legally obligated to protect your confidential information, the same as I am.  He will not disclose any identifying information about you that I share with him to any other person.  Even though he has to keep records of our supervision sessions and may have to share his records with the Kansas Behavioral Sciences Licensing Board, he will not keep any records that include identifying information, such as your name. 

Jim’s contact information is provided below in case you would like to talk with him about any aspect of  his supervision of the work you and I are doing together. 

I am providing a copy of this letter to you today, and also keeping a signed copy for my records.  Please feel free to ask me any questions at any time about my clinical supervision process.


                                                                                                                                                                                                                    Susie Social-Worker, LMSW

                                                                                                                                                                                                                      Susie Social-Worker, LMSW

Jim Kreider, LSCSW

Kreider Consulting, LLC

1706 Learnard Avenue

Lawrence KS 66044





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Client                                                                          Date

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