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Application for EMDR Therapy Consultation
Name *
Email Address *
Address 1 *
Address 2
City
State *
Zipcode *
Phone Number *
Degree *
License State and Number *
When and where did you receive your Level 1 & 2 EMDR Therapy training? *
Please list any additional EMDR Therapy trainings you have completed:
Please note which group you wish to join the Monday Morning Online Web Group or the Friday Afternoon Towson Group: *
Certification Status *
Please describe your general treatment approach to include other modalities you integrate into your clinical practice. *
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