Consultation Request Form
Welcome to Long Island EMDR!

At Long Island EMDR, we know the best predictor of your success in therapy is the connection you have with your therapist. It's ALL about finding someone who is a great fit for you! In this brief questionnaire, we are going to gather a little information about your current struggles, goals for therapy, and even your preferred days and times for appointments!
Sign in to Google to save your progress. Learn more
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of suffolkfamilytherapy.com.

Does this form look suspicious? Report