Therapist Referral- Winter/Spring 2024

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Couple Referral for Understanding Your Relationship's Enemy

A Psycho-education Course to help your couples learn their cycle and progress through stage 1 of EFT.

Course will meet alternating Thursdays
2/29, 3/14, 3/28, 4/11, 4/25
6:00 - 7:30 pm Pacific

Referring Therapist Name *

Referring Therapist Email *

Referring Therapist Organization

Partner 1 Name *

Partner 1 Email Address *

Partner 1 Position in Cycle

Partner 2 Name *

Partner 2 Email Address

Partner 2 Position in Cycle

By checking the box below and submitting this form I am agreeing to participating: 1) in free pre-group orientation; 2) that I have an ROI on file permitting consulting with group leaders as needed during the group; 3) and that I will participate in post group evaluation. I attest that I have training in Emotionally Focused Couples Therapy, with an EFT Externship or higher, and the couple is currently engaged in EFCT with me. *

I understand and affirm the above statement

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms