Growing Branches Counseling EMDR Intensive Interest Form
Fill the form below and we will get back soon to you for more updates and plan your appointment.
Name
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First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
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What are goals for your EMDR Intensive?
Please select all that apply to your journey:
I am currently seeing a Therapist
I have been in Therapy in the past
I have experience with EMDR Therapy
I have not been in Therapy
If you have been in Therapy, please describe your best and/or worst experiences
If you have been taking medication, please list below. If not, type N/A
How did you hear about Growing Branches Couseling?
I agree to receive notification to schedule a free 30 minute phone consultation with Amy Wagner, Growing Branches Counseling.
Yes
No
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