Free 30-Minute General Assessment Free 30-Minute Assessment Questionnaire - General Assessment The free 30-minute assessment we offer at The Gateway Institute provides a way for a potential client to meet us, experience our treatment center, and understand what therapy would be like if they were to move forward with treatment. The assessment will also provide you with a greater educational understanding of OCD or anxiety condition that you are currently dealing with and how The Gateway Institute can help you personally. The assessment is completely free and confidential. If you have any additional questions about the assessment feel free to contact us otherwise, please fill out the information below and we'll contact you soon to schedule the assessment in person or over the phone.Please rate your current level of anxiety.MildModerateSeverePlease check all condition(s) you're seeking treatment for Obsessive-Compulsive Disorder (OCD) Generalized Anxiety Disorder (GAD) Social Anxiety Disorder / Social Phobia Panic Disorder Post-Traumatic Stress Disorder (PTSD) Body Dysmorphic Disorder (BDD) Trichotillomania Have you ever received treatment for this condition(s) before? Yes No Are you contacting on behalf of a loved one? Yes No Are you currently taking medication? Yes No Age5-1011-1516-1819-2424-3334-4041-5051-90Name* First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Additional information you wish to provide:
