EMDR Consultation Inquiry
Please complete and submit the inquiry form below. I will follow up with you personally to discuss next steps.
Name
*
First Name
Last Name
Contact Number:
*
Format: (000) 000-0000.
E-mail
*
example@example.com
When did you complete your basic training and with which trainer
*
Are you an EMDRIA Certified Therapist
*
Yes
No
What type of consultation are you interested in?
*
Individual
Both
Group
Not Sure
If you are interested in Group Consultation, please select your preferred Spring 2026 group below:
Mondays beginning 3/16/26
Tuesdays beginning 3/10/26
Fridays beginning 3/27/26
No preference
Please let me know the best way to follow up—email, phone, text or zoom?
*
Email
Phone
Text
Zoom Meeting
Would you like to stay connected?
*
Please Select
I am willing to receive occasional marketing communications through automated messaging.
I am not willing to receive occasional marketing communications through automated messaging.
What are your goals for consultation at this stage of your EMDR development?
How did you come across our consultation practice?
*
Submit
Should be Empty: