Contact Form
For New Clients
Please fill out the form below today to set up your free 15-20 minute discovery call or to connect with a provider. A member of our team will reach out to schedule your call within 24-48 business hours. We look forward to connecting!
For existing clients, please connect via direct contact with your therapist or by using your client portal. Direct contact information can be found on each therapist's 'about' page.
Confidentiality
Please share what you are comfortable with. We value HIPAA and confidentiality, and it is important to know that this form is encrypted and HIPAA compliant for your privacy.
How did you hear about us?
Please Select
Google Search for OCD
Google Search for anxiety
Google Search for child therapy
AI search (Chat GPT, Perplexity, Claude, etc.)
Psychology Today
International OCD Foundation
I am a returning client.
I was referred by a family member or friend.
I was referred by a former or current client of the practice.
I was referred by a provider.
My child's school referred us.
Other
Referral source
If you were referred by a provider, center or clinic, what is the name of the company or provider?
Name of Referral Source
We'd love to learn...
The person completing this form is...
Please Select
The client
A parent or guardian of the client.
A loved one or friend of the client.
A provider.
OAO team member
Name of the client
First Name
Last Name
Age of the client.
Preferred pronouns of the client
She/hers, he/his, they/them, she/they, etc.
Name of the person completing this form (parent, loved one, provider, etc.)
First Name
Last Name
Who should we ask for when returning your message?
Name
Preferred email
example@example.com
Preferred phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you okay with us leaving you a text, email, or voicemail?
Please Select
I prefer you call back, and I am okay with leaving a voicemail).
I prefer a text first.
I prefer email.
I am okay with all forms of communication.
I prefer you reach out via text, email and call/voicemail for best chance of us connecting.
Please let us know your preferred method of communication.
What therapy location interests you most (in-person or telehealth)?
In-person therapy only, please.
Video/telehealth therapy would work well for me.
I prefer to meet my therapist in person once or twice, but after that, telehealth would appeal to me most.
I am open to either option with my best-fit therapist.
What type of therapy are you seeking?
Please Select
Child (Ages 6-12) OCD/anxiety
Teen (Ages 13-17) OCD/anxiety
Young adult (Ages 18-24) OCD/anxiety
Adult (Ages 25-40) OCD/anxiety
Adult (Ages 41-60) OCD/Anxiety
Adult (Ages 61+) OCD/Anxiety
Please share a bit about your reasons and desires for seeking therapy.
Please include information relating to OCD/anxiety and information outside of this subject area if relevant. We are here to support you with your OCD and anxiety and other areas of your life.
Please briefly share how much your symptoms, stressors, and/or experiences are impacting you (your child or loved one). We understand how debilitating OCD, anxiety, depression and other concerns can be.
Please share if OCD/anxiety or other stressors are impacting your ability to eat/appetite, sleep, socialize/maintain/develop relationships, mood and energy, regularly attend work or school, suicidal thoughts, fear of leaving house or going certain places, etc. We will discuss this more in detail if you become a client, but this will help us make appropriate recommendations during our free consultation call.
Please share about any preferences in a therapist below.
Please list if you have a preference on the gender of your therapist, preferences relating to religious or spiritual beliefs, in-person or telehealth, certain days you are available (Monday through Thursday only), etc.
Outsmarting Anxiety & OCD (OAO) is a private pay practice, meaning fees for session are due at the time of service. Our standard session rates (45-50 minutes) are $225. All of our clinicians are effectively trained in anxiety and OCD, and we each have our unique niches within our specialization of anxiety and OCD. We collect a credit card to put on file to charge at the start of each session, so we do not have to chat about payment each session for convenience. We accept all major credit cards and HSA/FSA cards.
This works for us. I want to consult with the therapist who would be the best fit for me/us.
I’d love to connect further on this. This may work for me/us.
This is outside of my budget, and I would love to see if OAO has referrals who also specialize in my needed area of treatment and meet my budgeting needs. If this option is selected, please describe your needs in the above area of this form titled 'Please share about any preferences in a therapist below.'
I am a provider/professional filling out this form, and thanks for this information.
Outsmarting Anxiety & OCD's providers each have their own unique schedule. OAO therapists provide therapy Monday through Thursday but do not provide therapy Friday, Saturday, or Sunday. The office is closed for the weekend beginning Friday at 12PM; we reopen Monday morning. We will do our absolute best to match you with a therapist who meets your scheduling needs.
I/we are generally flexible and look forward to hearing about current availability.
I/we would like to wait for an opening for our preferred time if clinically appropriate.
Other
Do you have questions for us? Other information you would like us to know? Please share here.
Thank you for reaching out and trusting us to be a part of your OCD and anxiety recovery journey. We look forward to connecting.
- Your Anxiety & OCD Team
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