EMDR Mentorship Application
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
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 is your primary goal for this mentorship?
Please Select
Path A: I am working toward EMDRIA Certification (Building the Foundation).
Path B: I am already Certified and want to master the Relational/Advanced craft (Deepening the Craft).
Other
How many consultation hours have you already completed toward certification (if any)?
What types of cases are you currently working with? (e.g., Complex Trauma, Attachment, Neurodiversity/ADHD, etc.)
How did you come across our consultation practice?
*
What is the biggest hurdle you’re currently facing in your EMDR work?
The EMDR Hub: This mentorship includes a private online space (The EMDR Hub) for peer connection. Do you agree to maintain strict HIPAA confidentiality and professional conduct within this space?"
Yes
No
The Financial/Time Commitment: I understand this is a 12-month commitment ($245/mo) with a cancellation window between the first and second group cohorts.
Yes
No
What specifically drew you to this mentorship over a standard consultation group?
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