Assessment

1. How much time do you spend on obsessive thoughts? *

2. How much do your obsessive thoughts interfere with your personal, social, or work life? *

3. How much do your obsessive thoughts distress you? *

4. How hard do you try to resist your obsessions? *

5. How much control do you have over your obsessive thoughts? *

6. How much time do you spend performing compulsive behaviors? *

7. How much do your compulsive behaviors interfere with your personal, social, or work life? *

8. How anxious would you feel if you were prevented from performing your compulsive behaviors? *

9. How hard do you try to resist your compulsive behaviors? *

10. How much control do you have over your compulsive behaviors? *

Patient Name *

Date *

Phone # *

Email *

Insurance Type *