Hope and Help for Obsessive-Compulsive and Related Disorders since 1991

Saturday, September 04, 2010

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New from Dr. Bruce Hyman...

Breaking Free
from OCD
9 Essential Principles for Getting and Staying Well

Buy the Audiobook
Learn More

The OCD Workbook
Rated the #1 Self-Help Psychology Book in 2008

The "Classic" Self-Help Manual for OCD
by Bruce M. Hyman, Ph.D. & Cherry Pedrick, R.N.

Intensive Cognitive Behavioral Treatment Screening Form

Confidential Patient Form

If you are interested obtaining intensive cognitive-behavioral treatment from the OCD Resource Center of Florida, please fill out the following screening form and send it to the Center. We will be back in touch with you to answer any questions you may have.

Please answer the following questions as best as you can. Your responses are completely confidential.

Your name:	First name & last initial only!
Phone number:
E-mail address:
Email will not be used for any other purpose than to communicate directly to you about treatment!
How to contact you:
Select intensive program:

Please list your current diagnosis, and any other diagnoses you have received.

What are your specific symptoms at the present time?

What is the effect of these symptoms on your daily functioning? Your job? Your family? Your relationship(s)?

When did you first notice these symptoms?

What sort of psychological treatment have you had for this disorder in the past? Has that treatment helped you?

Are you presently on medication for your disorder/anxiety? If so, what psychiatric medications you are presently on?

Enter the text exactly as
displayed below: (case-sensitive)

Thank you for the information — we will be contacting you in the next 24 hours.

Bruce M. Hyman, PhD, LCSW
Director of the OCD Resource Center of Florida [send email]