CBT Center's Obsessive-Compulsive Disorder (OCD) Support Group Interest Form
Thank you for your interest in the CBT Center's Obsessive-Compulsive Disorder (OCD) Support Group! This group will be held virtually, via Zoom.

Please take a few minutes to fill out this quick form.

Please keep in mind that membership for the OCD Support Group will be open until the group is full. After the group is full, we can place you on a waiting list or provide you with resources for alternative OCD support groups.

This form should only be completed by people 18 years and older. If you are younger than 18, please have a parent or legal guardian complete it for you.

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Email *
How did you hear about our groups? *
If referred to us, please indicate who sent you our way.
What is your first name? *
What is your last name? *
What is your date of birth?

Please note: We treat middle school-aged through older adult - ages ~12+ *
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What is the best way to contact you? 

Note: text messages and email make it easier for us to get back to you more quickly between meetings, etc.
 *
What is your phone number? *
What is your preferred email address? *
What are you hoping to get out of this support group? (just a few bullet points) *
Are you currently engaged in individual treatment? *
Have you ever participated in a support group before? *
*If you currently are having suicidal thoughts in addition to having plans or the means to do so, please go to the nearest emergency room, call 911, call the National Suicide Prevention Lifeline (1-800-273-8255), or text “START” to the Crisis Text Line (741741). If you are outside of the country, please call the local emergency line immediately.*
Please confirm that you understand the following:

Confidentiality and privacy for the members of this support group are a priority. I will never record our meetings, and members will be asked not to take pictures, video, or audio recordings.  Confidentiality concerns should be immediately brought to the attention of the facilitator. This peer-led support group is not intended to offer medical advice or serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified professional psychologist, psychiatrist, physician, or healthcare provider. In the event of an emergency or crisis, call your doctor or 911 immediately, or call the National Suicide Prevention Lifeline at 988. 

Please confirm that you understood the above paragraph and are willing to protect the confidentiality and privacy of this group:
 *
What state(s) will you be located in during support group meetings?
 *
Required
Do you have any special requests regarding your participation in the support group? What else is important for us to know? *
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