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What concerns are you hoping to address?

Please check any that apply to you

OCD or intrusive thoughts Anxiety or panic Specific fears or phobias (e.g., vomiting, contamination, flying, driving, etc. Fear or distress related to physical sensations or health symptoms Eating or food-related concerns Body image concerns Tics or Tourette’s Trauma or stress-related symptoms Parenting or family support Other

Have you previously received treatment for these concerns? If yes, please briefly describe what type of treatment you received and whether it was helpful.

Enter N/A if you have not participated in treatment prior

The treatment approaches used in this practice often involve learning skills and gradually facing feared situations (Exposure and Response Prevention). Are you open to this type of approach?

Yes Maybe No

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