Thank you for your interest in the CTSA.  We offer diagnostic evaluation and outpatient treatment for obsessive compulsive disorder, posttraumatic stress disorder, and anxiety-related disorders. In order to be sure that we will be a good fit for treatment at our specialty clinic, we ask that you answer the following questions to the best of your ability. Once we have received your responses, we will be in touch to schedule an initial in-person evaluation or to provide you with appropriate referrals.

Due to the continuing outbreak of COVID-19, we are actively developing treatment options through telehealth. As the situation is changing daily, more detailed information can be provided at the time of the phone screen. If you are experiencing anxiety related to COVID-19, please indicate below.

This questionnaire is hosted on a confidential server. The security of your information is of great importance to us.

**Please note that completion of this questionnaire is a prerequisite to being accepted as a new patient and does not guarantee that CTSA will provide therapy services for you or your child.**

Thank you!

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