11 TEESSIDE UNIVERSITY DOCTORATE IN CLINICAL PSYCHOLOGY – FORM NB Patient/Client/Carer/Colleagues/Staff column should be completed by using a Code e.g. Client/Patient A, Client/Patient B in order to provide anonymity and confidentiality. Patient/Client/ Module Title Academic Informed Practice Mentor/ Practice Mentor/ Student Date Carer/Colleague/ Support Consent Supervisor Supervisor Signature Teacher Gained Name Signature Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Form Ref: SoH Stuexp 37 15/08/02
11 TEESSIDE UNIVERSITY – DOCTORATE IN CLINICAL PSYCHOLOGY FORM NB Patient/Client/Carer/Colleagues/Staff column should be completed by using a Code e.g. Client/Patient A, Client/Patient B in order to provide anonymity and confidentiality. Patient/Client/ Carer/Colleague/ Module Title Academic Support Teacher Informed Consent Gained Practice Mentor/ Supervisor Name Practice Mentor/ Supervisor Signature Student Signature Date Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Form Ref: SoH Stuexp 37 15/08/02
Clinical%20Practice%20Handbook%202015-16(1).docx