EMDR Declaration Form

EMDR is a highly researched psychotherapy modality that uses eye movement and other bilateral stimulation.

In most cases we process painful/stressful situations successfully. We think about it, talk about it, cry about it, and we dream about it. The memory is adaptively stored, integrating with other similar experiences about ourselves and others.

However, disruption to the information processing, usually due to high arousal states from traumatic experiences, results in memories that are inadequately processed.

EMDR uses reprocessing techniques to support the recipient to go back and complete the process and reach a resolution.

The initial EMDR session will go for 90 minutes ($250) to set up safety processes to ensure that you can regulate yourself safely between sessions.

All subsequent sessions will go for 50 minutes at $185

Please review our Terms of Service below and confirm your acceptance of the terms by ticking the box on the intake form.

EMDR Declaration

Please review our Terms of Service below and confirm your acceptance of the terms by ticking the box below and on the intake form.

I acknowledge that everything experienced in this practice is not intended to replace orthodox medical treatment, but to be used in conjunction with it. I give consent to enter this process.

I accept that I need to commit to at least 5 sessions for optimum outcome.

If I cancel an appointment with less than 48 hours’ notice, I am liable to pay 50% of the full session cost.

If I cancel with less than 24 hours’ notice or do not attend my appointment, I am liable to pay the full cost of that session.

I agree to make payment before the start of each session to:
The Healing Process, BSB: 313-140 Acct # 12248261

I have reviewed and accept the terms of the above Declaration.

Date

Initials

Thanks for submitting!

EMDR Declaration Form

Please review our Terms of Service below and confirm your acceptance of the terms by ticking the box below and on the intake form.

The Healing Process Acknowledge