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Documentation and Recommendation Requests

This page is for requesting documentation of hours, recommendation letters for EMDR credentialing applications.
 

Both options below are requests for me to personally prepare professional documentation. 

PLEASE READ BEFORE SUBMITTING A REQUEST

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  • These forms do not automatically generate an attendance verification, letter, or other document.

  • When you submit a form below, you are sending one request to me to personally review your consultation records and prepare professional, consolidated documentation.

  • Please submit ONE request only. Do not submit a separate request for each consultation appointment or group. Your single request should include all applicable consultation hours you completed with me for the credential you are pursuing.

  • Individual attendance confirmation emails are separate from the professional consolidated documentation requested on this page and are automatically sent approximately 24 hours after the group.

  • Submitting duplicate forms or sending additional requests does not expedite processing.

  • This page is not for requesting a peer/colleague letter for your certification application. Per EMDRIA requirements, peer/colleague letters should come from individuals who did not provide your EMDR consultation.

  • CITs applying for Approved Consultant status: If you declared CIT status on or after January 1, 2026, EMDRIA no longer accepts letters from consultants. Instead, I complete EMDRIA's online CIT Verification, Evaluation, and Recommendation (VER) form. Submitting a request on this page is how you ask me to complete your VER. See the CIT notes under each option below.

Standard Processing

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  • Standard processing is included at no additional cost.

  • I aim to complete standard documentation requests within 30 days, although processing may take longer around holidays, scheduled office closures, or periods when I am out of the office. 


Need Guaranteed Faster Processing?

See options for expediting here

CONSOLIDATED DOCUMENTATION OF CONSULTATION HOURS

(No recommendation)

 

👉 Complete this if you need ONE document verifying all applicable consultation hours you completed with me.

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  • This request is for one consolidated document.

  • On the form, you will list ALL applicable consultation dates and hours you completed with me for the credential you are pursuing.

  • Do not submit a separate form for each consultation date or group.

  • Individual attendance confirmations sent after consultation are separate from this request.

  • This form does not resend or generate individual attendance confirmation

  • This documentation verifies your consultation hours only. It does not include a recommendation for EMDR certification.

  • If you need both documentation and a certification recommendation from me, complete the Certification Recommendation + Documentation Form.

  • For CITs who declared on or after January 1, 2026: Use this form if I am not your majority-hours consultant. Submitting it asks me to complete EMDRIA's online VER for the consultation-of-consultation hours you completed with me. Your VER will include verification of your hours with me and my evaluation of the consultation work I observed. EMDRIA requires a recommendation only from your majority-hours consultant, so a recommendation from me isn't needed on this path.

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REQUEST CONSOLIDATED DOCUMENTATION​

🔗 https://form.jotform.com/251405164974055

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CERTIFICATION OR APPROVED CONSULTANT RECOMMENDATION + DOCUMENTATION OF HOURS

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👉 Complete this form if you need ONE document that includes both documentation of your applicable consultation hours with me AND my professional recommendation for your EMDR certification or Approved Consultant application.

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  • Consolidated documentation of your applicable consultation hours with me

  • My professional recommendation for the EMDR credential you are pursuing, if I am able to recommend you

  • Any required evaluation of your EMDR practice within the scope of the consultation I provided

  • For CITs who declared on or after January 1, 2026: Use this form if I am your primary/majority-hours consultant. Submitting it asks me to complete EMDRIA's online VER, including verification of your hours, my evaluation, and my recommendation determination.

  • For CITs who declared before January 1, 2026 and are applying under EMDRIA's old requirements: Submitting this form asks me to prepare a letter addressing the quality of your consultation and documenting your hours.

  • Please allow approximately 20–60+ minutes to complete this form. Completion time will vary depending on the credential you are pursuing, your responses, your unique processing style, and the level of detail you provide. Progress cannot be saved once you start.

 

To provide a recommendation:

  • Certification: I require at least 10 individual certification-level consultation hours with me.

  • Approved Consultant Applicants: I require at least 10 individual CIT consultation-of-consultation hours with me, plus my other primary-consultant requirements listed on the Become a Consultant page.

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REQUEST A RECOMMENDATION​

🔗 https://form.jotform.com/232965659696176

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*What Is a Primary Consultant?

What Is a Primary Consultant?

Your primary consultant is the Approved Consultant who knows your work well enough to evaluate your readiness and who takes responsibility for recommending you. EMDRIA's rules about this differ by credential:

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For EMDRIA certification: EMDRIA requires a recommendation letter from one or more EMDRIA Approved Consultants (not a CIT). EMDRIA doesn't require that letter to come from the consultant who provided the most hours. My own policy is that I write certification recommendations only for consultees who have worked with me as their primary/recommending consultant and met my requirements, including at least 10 individual certification-level hours with me. See EMDRIA Certification with Sam for details.

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For EMDRIA Approved Consultant status: EMDRIA requires a recommendation from the Approved Consultant who provided the majority of your consultation-of-consultation hours. If I'm your majority-hours consultant, my primary-consultant requirements apply before I can recommend you. See the Become a Consultant page for details.

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**Why Is a Recommendation Required from my Primary Consultant?

A recommendation from your primary consultant serves several important purposes:

  • Verification of consultation hours
    The primary consultant confirms that you have completed the required number of consultation hours.

  • Clinical competency endorsement
    The letter attests that you demonstrate appropriate understanding and application of EMDR therapy, including case conceptualization, pacing, safety, and ethical practice.

  • Professional readiness
    EMDRIA requires an experienced consultant to assess whether you are ready to move forward with certification or Approved Consultant status.

  • Accountability and integrity of the certification process
    This ensures that certification is based on observed consultation work, not just self-report.

 

Because a recommendation is an endorsement of your competency, I provide one only when I've served as your primary consultant and know your work well enough to evaluate it. For certification, that's my policy. For Approved Consultant status, EMDRIA also requires the recommendation to come from your majority-hours consultant.

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Additional resources/information

Please visit EMDRIA at www.emdria.org for further information on these requirements.

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Please visit ICM's website for more information about ICM, additional requirements of ICM trainees, and to find consultants with specified focuses at https://www.instituteforcreativemindfulness.com/consultation/

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General info about ICM’s basic training requirements and consultation hours as well as info about moving onto certification: https://www.instituteforcreativemindfulness.com/emdr-therapy-training/

 

More from EMDRIA on training and certification is available here: https://www.emdria.org/

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Certificate in advanced dissociative Studies: https://www.instituteforcreativemindfulness.com/advanced- certificate-in- dissociation/

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Certificate of Expressive Arts Therapy with ICM: https://www.instituteforcreativemindfulness.com/certificate-of- expressive-arts-therapy/

 

More on Registered Expressive Arts Therapy requirements: https://www.ieata.org

4041 N High St Ste 300H/Columbus, OH/43214 
Email: sbergstein@mantramentalhealthllc.com
Fax: 614-319-5618

See the Therapy Services tab for your therapists contact info or telehealth link

 

Sam Bergstein, LCSW (CA #136811), LISW-S (OH #I.1901939-SUPV)

Licensed to provide psychotherapy in California and Ohio.
 

Therapy services:
Telehealth and in-person services are currently available to clients located in Ohio. I am not currently accepting new Ohio therapy clients.

Telehealth services are not yet available to new clients located in California. Please see the “California Therapy Services” tab for updates.

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Mantra Mental Health LLC provides psychotherapy and professional consultation services. Consultation services are for clinicians and are not psychotherapy or mental health treatment.

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Use of this website or its resources does not establish a therapeutic relationship.

-Records requests: For professional (another provider or legal support) records requests, please fax a release of information and request to our fax number. I will not respond to phone calls or emails about records requests.

© 2026 by Mantra Mental Health LLC

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