EMDR Therapy Intake and Trauma History Questionnaire
EMDR Therapy Intake and Trauma History Questionnaire
Structured intake for EMDR clinicians capturing trauma history, target memories, resourcing readiness, and dissociation screening before reprocessing.
Client full name *
Your answer
Date of birth
Phone
Referring provider (if any) *
Your answer
Presenting concerns
Your answer
Previous therapy experience
Your answer
Have you experienced any of the following? (check all that apply)
+ 16 more questions
About this template
Structured intake for EMDR clinicians capturing trauma history, target memories, resourcing readiness, and dissociation screening before reprocessing.
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