OCD Assessment Form
Please fill the Form below. Answer all the Questions. Dont think too much. Fill it With The Answer that comes first to your mind. Your response will be kept confidential. It will be used only for treatment and research purpose. Copyright © 2021 psyclinic
Your name/Nick name
Email
example@example.com
Date of filling the form
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Month
-
Day
Year
Date
Do you have the habit of using substances like alcohol, cannabis, opiates, nicotine etc. If yes please specify the type of substance, quantity of intake, how often you take it etc.
How often you feel the following
Never
Rarely
Some times
Most times
Always
thinks that others bodily secretions like saliva, urine ec. may contaminate me and causes disease
Wash and clean my hands excessively
I feel afraid to throw away certain things even if it is useless
very particular about arranging and putting things in order
checks things as a routine almost in the same order before going to bed
Keep checking again and again to make sure of its accuracy
very concerned about cleanliness
dont like to take things that are touched by others
ask people to repeat things again and again to check its correctness
checks gas cylinder, switches, taps etc. repeatedly even after switching it off.
checks locks repeatedly
afraid that you may hurt or harm others
always makes sure that family members are washing their hands
feels irritated when others keep your things not in order
checks several times the forms you have filled up
I believe in lucky and unlucky numbers and places
I feel that I could not do things fast because of my repeated rechecking
Dont like to touch garbage or other dirty things
I have bad thoughts which are uncontrollable
Even after doing something I feel doubtful whether I have done it or not
I follow a particular order while doing something like washing face etc. and changing the order makes me uncomfortable
I dont like to get touched by others
Signature
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