Enter your information below to schedule a 30-minute phone consultation for an EMDR Intensive

EMDR Intensive Interest Form

Name

First Name

Last Name

Email

Phone

(###)

###

####

What are your goals for an EMDR Intensive?

Please select all that apply:

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 before.

If you have been in therapy, please describe your best and worst experiences.

If you are taking medication, please list below. If not, put NA.

How did you hear about Mindful Living Counseling?

I agree to receive a text message to schedule a free 30 minute phone consultation with Lauran Hahn.