Free 30-Minute Assessment The free 30-minute assessment we provide offers a way for us to meet one another and offers you the experience of our therapeutic approach and treatment center. The assessment will also provide you with a greater educational understanding of OCD or anxiety condition 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. Type of Obsessions - Check all that apply Agressive- Harming Self or Others Contamination - Excessive Concern w/ Dirt, Germs, Secretions, Environment Sexual Obsessions- Perverse Thoughts, Fears Hoarding - Concern with Objects Religious- Blasphemy or Morality Need for Symettery or Exactness Miscellaneous Obsessions- Doing, Saying the Right Thing, Intrusive Thoughts, Numbers Somatic Obsessions- Concern with Illness or Body Parts Type of Compulsions - Check all that apply Cleaning / Washing Compulsions Checking Compulsions Repeating Rituals Counting Complusions Ordering / Arranging Compulsions Hoarding . Collecting Compulsions Miscellaneous Compulsions Trichotillomania Have you ever received OCD treatment before? Yes No Are you currently taking medication? Yes No Are you contacting on behalf of a loved one? Yes No Name* First Last Age5-1011-1516-1819-2424-3334-4041-5051-90Address 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* Other Info
