MQ EMDR Intensive Form | Mindset Quality, LLC

I understand that EMDR intensive services are NOT covered by insurance. I may submit for out-of-network reimbursement on my own. Mindset Quality LLC does not bill insurance for intensive services.

I understand that payment must be paid in full before my intensive is confirmed. Payment options include credit card and Afterpay.

I understand that all sales are final. No refunds will be issued. One (1) rescheduling is permitted with at least 72 hours advance notice.

I understand that submitting this form does not guarantee services. Dr. Jordan reserves the right to decline or redirect any inquiry based on clinical fit and availability.

I understand that if I am currently in therapy, I am encouraged to inform my current provider before beginning an intensive.

EMDR Intensive Inquiry + Intake Form