EMDR Note Template
A complete clinical documentation bundle designed by Sherly Millan, LICSW, for real EMDR sessions.
Track targets across sessions: Memory/Trigger, Negative Cognition (NC), Positive Cognition (PC), Validity of Cognition (VOC), and SUD scores — all in one clean grid.
Capture each session completely: Safe Place, BLS modality and sets, Cognitive Interweave, SUD baseline and close, Installation, and Body Scan.
Watermarked preview — the downloadable PDF is clean and unbranded.
What's Included in the Bundle
- Negative Cognition (NC) and Positive Cognition (PC) per target
- Validity of Cognition (VOC) baseline and end scores
- Subjective Units of Disturbance (SUD) tracked across sets
- BLS modality, speed, and number of sets
- Cognitive Interweave documentation
- Safe Place, Installation phase, and Body Scan
How to Use This EMDR Note Template
Use this template during each EMDR session to maintain thorough clinical documentation across all 8 standard protocol phases. Begin by recording the target memory and baseline SUD score before desensitization. During processing, note the type of bilateral stimulation used — eye movements, tapping, or auditory tones — along with the number and duration of each set. Track SUD levels after each set to monitor progress. Document any cognitive interweaves you introduce when processing stalls, and record the Positive Cognition and VOC score during the Installation phase. Complete the Body Scan section before closing. This template follows the standard EMDR protocol phases established by Francine Shapiro, ensuring your notes meet clinical and insurance documentation requirements.
Insurance-Compatible EMDR Documentation
Structured EMDR documentation supports medical necessity for insurance billing. These templates track AIP-model phase progression and SUD/VOC outcomes — the clinical data payers need to justify EMDR treatment.
Compatible with CPT codes 90837, 90834, and 90847.Get the Bundle — $12
Both templates included. Instant PDF delivery to your inbox. Designed by a licensed EMDR therapist.
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