EMDR Session Feedback Form
Please share your feedback about your recent EMDR session to help us improve your experience.
Full Name
*
First Name
Last Name
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you rate the overall effectiveness of this EMDR session?
*
1
2
3
4
5
How comfortable did you feel during the session?
*
Very comfortable
Somewhat comfortable
Neutral
Somewhat uncomfortable
Very uncomfortable
Which EMDR techniques were used in your session? (Select all that apply)
Bilateral stimulation (eye movements)
Tapping
Auditory tones
Other
How would you rate your therapist's approach during the session?
*
1
2
3
4
5
Would you recommend EMDR therapy to others?
*
Yes
No
Not sure
Additional comments or suggestions
Submit Feedback
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