Example EMDR Case Presentation Form

Consultees use this form to summarize the EMDR case they choose to bring for discussion during the consultation process.

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Example EMDR Case Presentation Form

Last updated: 02/26/2026

The purpose of this EMDR Case Presentation Form is for the consultee to use this form to summarize the EMDR case they choose to bring for discussion during the consultation process. Case presentation details can be outlined and summarized by the consultee so the consultant can provide guidance and feedback on their use of EMDR with clients. Both consultants and consultees are welcome to use the form as is, make modifications, or use other resources for the consultation process.

Date of Consultation: __ Consultation # __

Demographics: (age, ethnicity, cultural considerations, rapport, etc.) __

Present Triggers: (current triggers, window of tolerance, current coping, safe/calm place, etc.) __

Past Experiences: (from float back/affect scan with age – emphasis on completed and started targets) __

Desired Future Goals: (from target sequence plan) __

Internal & External Resources: (include existing & needed resources) __

Clinical Themes: (responsibility, self-worth, safety, control, choices) __

Brief Summary of the Case Status: Have reprocessing phases been initiated with this client? If so, how many targets have been addressed? Please describe the client’s current clinical presentation and overall status at the time you are bringing this case to consultation. __

Key Focus/Question: (procedural questions, BLS, stuck points, blocks/feeder memories, cognitive interweaves, etc.) __

Additional Considerations: __

Diagnosis: __

Assessment Scores at Intake (as applicable to the practice setting): __

Additional Relevant Notes of Questions: __