top of page

EMDR Intensives Questionnaire

The screening questions below will help me determine if an EMDR Intensive may be a good fit for you. Answering “yes” to any question does not prevent you from being a candidate but it does help me be prepared to ask the right questions and provide meaningful supports. Your answers to these questions will not be shared with anyone.

Are you able to come to Northern Colorado (Fort Collins or Denver) in-person for your intensive? This may involve costs such as travel and booking one night to several nights at a hotel or AirBnb.
Yes
No
No, I want my intensive to be online (only available for 3-hour sessions)
Have you been hospitalized for psychiatric reasons within the past 12 months?
Yes
No
Do you currently have any thoughts of self harm, self harm behaviors, thoughts of suicide/homicide? Check all that apply.
Are you currently struggling with alcohol or drug use?
Yes
No
Other
Have you ever been in therapy before?
Yes
No
How long have you attended therapy?
Never
0-6 months
6 months-1 year
1-3 years
Other
Do you have a current therapist?
Yes
No
Are you willing to have me communicate with your current therapist to discuss goals, progress, and incorporating lessons from our intensive into your sessions together?
Yes
No
I have no therapist
Yes, But... (explain what you wish discussed versus withheld in box at bottom of form)
Have you ever done EMDR before?
Yes
No
Is the event you want to address with EMDR a single incident or an ongoing issue? Choose all that apply.
How long ago did this event occur?
bottom of page