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Black EFT (BEFT) Information Form
Welcome to the BEFT family! Please take a moment to complete this registration form to be included in monthly meetings, upcoming events and opportunities to be supported in your EFT journey.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
How did you hear about this group?
Your answer
Clinical License Status (e.g. LPC, Psychologist, Associate, Student)
Your answer
Affiliation/Organization/Practice (e.g., name of private practice, university affiliation, community clinic)
Your answer
Location (i.e., San Diego CA)
Your answer
Level of EFT Training
*
No official training, but interested in the EFT model
Externship In Process
Receiving EFT Supervision
Completed Externship
Core Skills In Process
Completed Core Skills
EFT Certified
EFT Certified Supervisor
EFT Trainer
Required
If you have a training area of expertise please include it below:
Your answer
Are you currently working with couples?
Yes
No
Clear selection
Are you currently accepting new couple clients?
Yes
No
I have a waitlist
Clear selection
Would you like your contact information to be included on the forthcoming BET website?
Yes
No
Clear selection
Please provide any other questions or comments; we would love to hear feedback about how the BET group can meet your needs:
Your answer
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