Referral List Confirmation Form5.01 Confirmation of Network/Mailing List Registration Thanks for checking in here to confirm/update your registration or otherwise with the EMDR Focus attachment-informed referral network.Read on down and the questions should explain themselves.It’s really important that colleagues on this network work in a clearly attachment-informed way, and stay up to date with latest ideas and approaches in this community.So if you’d like to stay on the network, either the full Directory, the Google Group referral list or both, every 12 months you will need to have joined the EMDR Focus team live online for at least two hours live workshop/consultation.Mark BrayneBefore going any further, do you want to stay on the EMDR Focus therapy/consultation referral system? (And of course fine either way…) * Keep me registered No longer one for meName * Name Given Given Family Name Family Name Phone * Thanks for being with EMDR Focus on the journey so far, and all best for the future. Please do however just complete the email box below so that we know to take you off the lists.MarkNote that you want to stay on our lists, you need to join us for a live event at least once every 12 months. See www.emdrfocus.com/workshops for what’s on offer. Please confirm that you have either attended in the past 12 months (supervision group, webinar, live session, full workshop etc) or that you’re now booked. Without that refresher, regretfully you can’t stay on our lists. * Yes, I’ve done that No, I haven’t Which EMDR Focus event(s) have you attended/are you booked on in the past 12 months or the year ahead? * If the above answer was a No, you won’t be able to submit this form and your listing will, sadly, be removed.It’s essential that anyone on our lists is at least somewhat up to date with what we specifically teach at EMDR Focus. That’s the deal!Please come back here and complete the form when you’ve made a booking.Which EMDR Focus referral network do you wish to stay on? (Tick all that are relevant – and NB inclusion in the Directory needs you to have done both Parts 1 AND 2 of Unleash Your EMDR).. * Therapy Referral Request List (Google Group) Directory Therapist with EMDR Focus Directory Consultant/ Supervisor with EMDR Focus Supervision/Consultancy Request List (Google Group) Email – please enter this twice to ensure there are no typos. * Confirm Email – please enter this twice to ensure there are no typos. * Any update to your status/qualifications/personal info etc in the last 12 months Updated Info No change neededCurrent accreditation/approval status (reminder, and now possible here to be with more than one): Are you accredited/approved by a national EMDR Association (e.g. EMDRIA/EMDR Europe/EMDRAA)? * Not formally accredited/approved EMDRIA EMDR UK/Europe EMDRAA EMDRNZ OtherOtherAny update in your Highest Level EMDR Qualification? No Change Foundational 3/4-part EMDR training Approved/ Accredited Therapist/Practitioner Consultant-in-Training Approved/Accredited Consultant Trainer in Foundational EMDRPlease check your Directory listing (the Find A Therapist tab at EMDRFocus.com)- anything you want changed? * Happy with my listing as it stands I’d like to edit my listingRemember, this is your shop window, your introduction to clients who might want to get in touch. Please make it personal as well as generic. Not too long, not too short either. It will be a combination of this text and your photograph which will inform visitors as to whose profile they wish to follow up. Here’s my updated blurb. * How do you work? * Online only In-Person Both Online and In-Person Where (town/postcode) are you based – we need to know this (at least your town) even if working solely online. * Second location you might like flagged up on the Focus Directory (Optional) Where are you registered for tax purposes? * AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Work with ASD/ADHD? * Yes NoExperienced in Work with OCD? * Yes NoWork with children * Yes NoWork with couples? * Yes NoI am currently available for client referrals. * Yes NoI am currently available for supervision/consultation requests * Yes No Preferred method of contact * EmailVia websiteTelephone I have regular (at least monthly) supervision in attachment-informed EMDR (this can include peer supervision). * Yes NoThis really matters. It’s essential that colleagues on this network regularly check in, both with other ai-EMDR therapists and with themselves, on how they’re actually delivering EMDR. Do you want to add a new, updated photograph for your public profile. Drop a file here or click to upload Choose FileMaximum file size: 516MBBy ticking the Yes box below, I agree that I may be contacted directly in relation to this service, and that if I am staying on the main EMDR Focus referral lists, either as Therapist or as Consultant, my profile and contact details may be made publicly available on the EMDR Focus websites. I note that EMDR Focus takes no further responsibility of any kind for work that might ensue from inclusion on any online referral list. I also acknowledge that EMDR Focus will, on request, immediately remove my information from any lists and that in managing these lists, EMDR Focus will observe all requirements of GDPR. * Yes NoI confirm that, depending on availability of course, I will do my best to answer requests appropriately and directly to client or therapist contacting me as a result of visiting the EMDR Focus website.. * Yes NoI confirm that I will attend at least two hours of live CPD with an EMDR Focus-approved Workshop/Webinar leader every 12 months for as long as I am on the EMDR Focus referral register * Yes NoSubmit If you are human, leave this field blank.
