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Forms

Here are some forms you may find useful for your learning and practice of EFT.

Forms and Handouts for Couples:

Case Presentation Form

Cycle Fill In Form

Dyadic Adjustment Scale

DAS Article for Scoring Info

Sample Video Release – Word

Sample-Taping-Request-Letter

“NO Secrets” Policy

Training Note Form

First Session Possible Questions

EFT Supervision Agreement

EFT Assessment and Session Notes

Learning EFT Helps and Self Review Forms

EFT-Fidelity Scale: Self Report Version and Article Abstract – check your knowledge and competency on important EFT skills

Self Supervision Checklist

Training Note Form

Video Session Review Form

For Supervisors and Supervision

Bug-In-Ear Informed Consent Sample Form

Case Presentation Form

Cycle Fill In Form

Supervision/Consultation Agreement

Supervision/Consultation Agreement – To You To Edit For Your Use

Cloud or Computer – Practice Management Info

How to make a video file an audio file, for transcription – by Alan Groverman

 For MAC                         For PC

Clinical Forms

Dyadic Adjustment Scale (DAS)

DAS Article for Scoring Info

Sample Video Release – Word

Sample-Taping-Request-Letter

Sample Video Consent by Sandy Jardine

“NO Secrets” Policy

First Session Possible Questions

Sexual Relations Assessment-no heading

EFT Assessment and Session Notes

Sandy Jardine’s After First Session Homework/Assessment Questions 

“This is the couples questionnaire I give to all couples at the end of the first session. I ask them to fill it out and get it to me either at our individual session or prior to it if at all possible.” Sandy Jardine

Forms and Handouts for Couples

FORM NAME PURPOSE
1. What is EFT Sample handout explaining EFT
AN EFT ROADMAP FOR COUPLES Explanation of goals of treatment. By Pat LaDouceur
2. Informed Consent (2012)

Informed Consent (2012) .doc format

Video Tape Consent is in this document.

Editable format

 3. Couples Questionnaire Used during intake and reviewed after first session
 4. Couples Screening Form (Doug Tilley) This is a self-reporting questionnaire about each person and their partner. It asks about specific contraindications – First DV assessment tool
 5. Couple Satisfaction Checklist A check list of areas of distress-easy to see hot spots in where the couple may experience conflict-helps with themes of distress
 6. Individual Problem Checklist Helps indicators to be aware of such as physical and relational patterns, stressors of past several years
 7. Attachment History Questions Brief Attachment History Questions Developed by Dr. Scott R. Woolley
 8. When We’re Not Getting Along Survey of thoughts, feelings and behaviors when couple is in conflict-beginning window into cycle
 9. Understanding Your Negative Cycle Assesses the couples’ ability to track their cycle-reaction patterns
 10. Attachment Questionnaire from Parenting From the Inside Out Provides an Introduction into their family of origin history
 11. About EFT- Psychology Today By Sue Johnson. Introducing EFT
 12. DAS_SpanierDAS ArticleDAS SCORING Snap shot of the couples and how distressed they are. Here is the assessment, the supporting article and the scoring.
 13. A – H List of assessment questions from list-serve addressing the areas you need to eventually cover in assessment
 14. Cycle Form with note linesTraining Note FormCycle Fill In Form To use as you’re mapping the cycle and learning EFT steps and interventions.
 15. Interpersonal Violence Assessment To assess for domestic violence
+ Forms for Therapists

Here are some forms you may find useful for your learning and practice of EFT.

Forms and Handouts for Couples:

Case Presentation Form

Cycle Fill In Form

Dyadic Adjustment Scale

DAS Article for Scoring Info

Sample Video Release – Word

Sample-Taping-Request-Letter

“NO Secrets” Policy

Training Note Form

First Session Possible Questions

EFT Supervision Agreement

EFT Assessment and Session Notes

Learning EFT Helps and Self Review Forms

EFT-Fidelity Scale: Self Report Version and Article Abstract – check your knowledge and competency on important EFT skills

Self Supervision Checklist

Training Note Form

Video Session Review Form

For Supervisors and Supervision

Bug-In-Ear Informed Consent Sample Form

Case Presentation Form

Cycle Fill In Form

Supervision/Consultation Agreement

Supervision/Consultation Agreement – To You To Edit For Your Use

Cloud or Computer – Practice Management Info

How to make a video file an audio file, for transcription – by Alan Groverman

 For MAC                         For PC

Clinical Forms

Dyadic Adjustment Scale (DAS)

DAS Article for Scoring Info

Sample Video Release – Word

Sample-Taping-Request-Letter

Sample Video Consent by Sandy Jardine

“NO Secrets” Policy

First Session Possible Questions

Sexual Relations Assessment-no heading

EFT Assessment and Session Notes

Sandy Jardine’s After First Session Homework/Assessment Questions 

“This is the couples questionnaire I give to all couples at the end of the first session. I ask them to fill it out and get it to me either at our individual session or prior to it if at all possible.” Sandy Jardine

+ For Your Couples

Forms and Handouts for Couples

FORM NAME PURPOSE
1. What is EFT Sample handout explaining EFT
AN EFT ROADMAP FOR COUPLES Explanation of goals of treatment. By Pat LaDouceur
2. Informed Consent (2012)

Informed Consent (2012) .doc format

Video Tape Consent is in this document.

Editable format

 3. Couples Questionnaire Used during intake and reviewed after first session
 4. Couples Screening Form (Doug Tilley) This is a self-reporting questionnaire about each person and their partner. It asks about specific contraindications – First DV assessment tool
 5. Couple Satisfaction Checklist A check list of areas of distress-easy to see hot spots in where the couple may experience conflict-helps with themes of distress
 6. Individual Problem Checklist Helps indicators to be aware of such as physical and relational patterns, stressors of past several years
 7. Attachment History Questions Brief Attachment History Questions Developed by Dr. Scott R. Woolley
 8. When We’re Not Getting Along Survey of thoughts, feelings and behaviors when couple is in conflict-beginning window into cycle
 9. Understanding Your Negative Cycle Assesses the couples’ ability to track their cycle-reaction patterns
 10. Attachment Questionnaire from Parenting From the Inside Out Provides an Introduction into their family of origin history
 11. About EFT- Psychology Today By Sue Johnson. Introducing EFT
 12. DAS_SpanierDAS ArticleDAS SCORING Snap shot of the couples and how distressed they are. Here is the assessment, the supporting article and the scoring.
 13. A – H List of assessment questions from list-serve addressing the areas you need to eventually cover in assessment
 14. Cycle Form with note linesTraining Note FormCycle Fill In Form To use as you’re mapping the cycle and learning EFT steps and interventions.
 15. Interpersonal Violence Assessment To assess for domestic violence

Sandy Jardine’s After First Session HomeworkAssessment Questions “This is the couples questionnaire I give to all couples at the end of the first session. I ask them to fill it out and get it to me either at our individual session or prior to it if at all possible.” Sandy Jardine

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