Consultation: Next Steps in Your Journey
I'm so glad you're here! Take a moment and fill out the form and we will be in touch soon to coordinate a time to learn about your practice and goals for consultation.
Name
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First Name
Last Name
Contact Number:
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E-mail
*
example@example.com
When did you complete your basic training and with which trainer
*
Are you an EMDRIA Certified Therapist
*
Yes
No
Not Sure
What type of consultation are you interested in?
*
Individual
Both
Group
Not Sure
Please let me know the best way to follow up—email, phone, text or zoom?
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Email
Phone
Text
Zoom Meeting
Would you like to stay connected?
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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.
How did you come across our consultation practice?
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