EMDR Informed Consent Template (Free Clinician PDF)
A printable, state-adaptable informed consent template for clinicians beginning EMDR with a new client — risks, benefits, alternatives, confidentiality limits, and signature blocks on a single PDF you can adapt and use.
Free PDF for EMDR clinicians. Get it by email.
What's in the EMDR informed consent template
A two-page printable informed consent document covering everything required for ethical consent to EMDR therapy: what EMDR is, what to expect in session, possible benefits, possible risks and side effects (including the more serious risks of destabilisation and dissociative reactions), evidence-based alternatives (TF-CBT, PE, CPT, NET, somatic approaches), confidentiality and its statutory limits, fees and cancellation policy, emergency contact information, and the client's right to refuse or withdraw consent at any time.
The second page is a signature page with separate blocks for client, parent/guardian (under 18), and clinician, plus dates. Bracketed italicised text marks the practice-specific fields you need to replace before printing — fee, cancellation window, jurisdictional law (GDPR, state privacy law, etc.), and your preferred contact method.
Who it's for
EMDR clinicians starting a new client and looking for a sound starting point for their informed consent paperwork. Particularly useful for clinicians newly trained in EMDR who are building intake materials for the first time, and for established practitioners who want to refresh consent language to explicitly cover EMDR-specific risks (abreaction, destabilisation, surfacing of additional memories) that generic psychotherapy consent forms often omit.
This template is a starting point and is not legal advice. Adapt it to your jurisdiction, licensure body, and practice policies before use. Review the wording with your professional liability carrier or attorney — some jurisdictions require additional disclosures (Good Faith Estimate under the U.S. No Surprises Act, GDPR data-handling language in the EU/UK, specific tele-health language in your state).
Why EMDR-specific informed consent matters
Most generic psychotherapy consent forms do not adequately cover the EMDR-specific risk profile: brief but sometimes intense activation during reprocessing, vivid dreams or fragmented memory recall between sessions, and the possibility of surfacing additional memories or material not originally targeted. Clients are far better prepared when the consent conversation has already named these possibilities — and clinicians are far better protected when the consent record reflects them.
The template also includes explicit language about the right to refuse bilateral stimulation, pause reprocessing, or end treatment at any time. This matters because EMDR involves direct contact with distressing material; the client needs to know up front that consent is ongoing, not a one-time signature.
How to use the template
1. Open the PDF and read the bracketed italicised fields. Replace each with your practice details (fee, cancellation policy, jurisdictional law, contact method).
2. Adapt the alternatives section if you want to add or remove modalities. The template includes TF-CBT, PE, CPT, NET, somatic approaches, and medication management — the standard evidence-based alternatives.
3. Review confidentiality language against your jurisdiction's mandated-reporting requirements. The template covers the standard limits (imminent harm, child/dependent abuse, court order, third-party releases) but state and country variations matter.
4. Walk through the consent verbally in session before signing — the document is the record, not the consent itself. Document the conversation in your session note.
5. Pair with Phase 1 history-taking and the Bilateral Stimulation client guide so the client also receives the procedural information about what reprocessing will feel like.
What's inside the PDF
- Page 1: 8 numbered sections covering what EMDR is, session expectations, benefits, risks and side effects, alternatives, confidentiality and its limits, fees and emergencies, and the right to refuse or withdraw
- Page 2: acknowledgement statement plus signature blocks (client, parent/guardian for under-18s, clinician)
- Adaptation notes for jurisdiction, tele-health, and professional liability review
Common questions about EMDR informed consent
Do I need a separate EMDR consent on top of my general psychotherapy consent? Best practice is yes, especially for clinicians who are EMDR-Certified or who advertise EMDR as a specialty. The EMDR-specific risks (abreaction, destabilisation, surfacing of additional memories) are not adequately covered by generic psychotherapy consent forms.
Should consent be verbal or written? Both. Walk through the document verbally in session, then sign. Document the conversation in your session note ("informed consent reviewed verbally and signed").
When does consent need to be revisited? Whenever the treatment plan materially changes — moving from EMDR to an integrated IFS/EMDR approach, adding tele-health, beginning child-adapted protocols, or moving from individual to intensive format. Document the conversation.
Is this template compliant with privacy regulations? It includes placeholders for confidentiality language aligned with common privacy frameworks. Adapt the bracketed text to match your specific Notice of Privacy Practices and the requirements of your state. The template alone does not satisfy privacy regulations — your privacy practices document does.
Related on the EMDR guide
Frequently asked questions
Is this template legal advice?
No. It is a clinical starting point. Review with your jurisdiction's licensure body, professional liability carrier, or attorney before use.
Can I edit the template?
Yes — the PDF is designed to be adapted. Replace the bracketed italicised fields with your practice details, and adjust the confidentiality and emergency sections to match your jurisdiction.
Do I need this if I already have a general consent form?
Most general psychotherapy consent forms do not adequately cover EMDR-specific risks (activation, destabilisation, surfacing additional memories). A separate or appended EMDR consent is best practice.
Is consent needed for tele-EMDR?
Yes — and the standard tele-health consent language should be added on top of this template. See the EMDR online guide for the practical considerations.
References
- American Psychological Association (2017, amended 2019). Ethical Principles of Psychologists and Code of Conduct.
- EMDR International Association (EMDRIA). Definition of EMDR Therapy, Basic Training and Certification standards. emdria.org (verify the current edition).
- Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.