5.1 Client Request Form

Thanks for connecting with us. This is where you can register a request for Attachment-Informed EMDR psychotherapy with a trusted EMDR Focus colleague.
GDPR: Before going any further, please confirm that you’re OK for the information in this form to be saved confidentially by EMDR Focus and forwarded automatically by email to EMDR Focus-associated therapists/supervisors who might currently have availability. Completing this form confirms that you give permission for these therapists to get directly in touch. Note that EMDR Focus takes no responsibility for any work or connection that may arise through submission of this form.
Are you asking for yourself, for a friend/someone else, or as therapist on behalf of a client
Your Name
Your Name



It would be helpful if you could indicate your (or client’s) rough age.
What’s your/the preferred way of working in this case? (Tick both if either is OK)

Optional. What days/times might work? Tick all that apply.
If we have available colleagues, how would you like to be contacted? Tick all that apply.
Note that this request will go to what’s now quite a large group (70+), so please be prepared to receive potentially quite a number of offers from which to choose.  It would be appreciated if you could acknowledge receipt of all emails.

Please indicate how you heard about EMDR Focus.