Therapist list application form for PTT EMDR members

first name:*

last name:*

degree:
magister doktor doktor habilitowany profesor
phone:*

email:*

website:

organisation / company name represented by:

town:*

street name and apartment no:

post code:

voivodeship:*
dolnośląskie kujawsko-pomorskie lubelskie lubuskie łódzkie małopolskie mazowieckie opolskie podkarpackie podlaskie pomorskie śląskie świętokrzyskie warmińsko-mazurskie wielkopolskie zachodniopomorskie other
country:*

EMDR degree:*
brak Practitioner Konsultant - superwizor Trener C&A konsultant - superwizor C&A Practitioner C&A Trener
therapy language:*

additional psychological competences
(apart from psychotherapist certificate):

age group of patients:*
children* youth adults
* may only be checked by therapists who have completed the workshop/training “EMDR for Working with Children” and are members of the EMDR Therapy Unit for Children and Adolescents