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 phone screening or to provide you with appropriate referrals.

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.**

Any individuals above the age of 18 seeking treatment must complete this survey themselves. If you are looking for services for your child (age 17 or younger, please complete this survey instead).

Thank you!

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