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Beth Holt Wright, LCSW
Licensed Psychotherapist in Virginia, North Carolina, and West Virginia
Eye Movement Desensitization and Reprocessing
Internationally Certified Clinician
(540) 492-4057
beth.holt.wright@gmail.com
How to Submit the Informed Consent Form
Sign and submit the form electronically
1. Click the Word icon below to download a copy of a word file.
2. Open the file in MS Word or another word processor.
3. The form is already initialed and signed by "John Doe." Use the find and replace feature to find all instances of the initials "JD" and replace with your own initials.
4. Find John Doe's signature and replace it with your own.
5. Find the date "1-1-24" and replace with the current date.
6. Save the file to your computer with an appropriate file name after the changes are made.
7. Email the file as an attachment to Beth at
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Sign and submit the form manually
If you are not comfortable submitting the form electronically, simply click on the PDF icon below. The form will open and you can print it from there and sign it manually. Then simply mail it to Beth at
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