OCD Intake OCD Intake Form Comprehensive (#34)Δ Subscribe General InformationWe’re here to help you on your journey to better mental health. To secure your 30-minute intake appointment, a non-refundable commitment fee of $40 is required. This fee covers the professional time one of our therapists dedicates to carefully reviewing your intake form, including the initial screening that is part of the intake process. Should you decide to proceed with additional OCD-related services—such as further assessment, skills training, or clinical therapy—the $40 will be credited toward your initial appointment. This policy ensures that each client receives thoughtful attention from the outset and supports an efficient scheduling process. Please note that commitment fee is waived for First Nations clients. Let's start with your name, phone number, email address, and birth date.Your First NameYour Last NameYour Best Phone NumberYour Best EmailDate of Birth (Month/Day/Year)Save & ResumePreviousNextCultural HeritageNow some questions about your Cultural Heritage. This section is essential to determine if you may qualify for NIHB funding.Are you a Canadian Indigenous individual?- Select -NoYes, First Nations or InuitYes, but non-statusYes, MN-SK CitizenPlease enter your full treaty card numberPreviousNextYour SymptomologyLet's briefly look at your mental health and OCD-related symptoms and why you are seeking supports.SymptomsPresentPersistent anxietyPersistent low moodPersistent stressI feel restlessCurrently grievingPersistent difficulties with sleepingI feel tired all the timeCurrently struggling with addictionsLittle interest or pleasure in doing things- Select -Not at allSeveral daysMore than half the daysNearly every dayFeeling down, depressed or hopeless- Select -Not at allSeveral daysMore than half the daysNearly every dayFeeling nervous, anxious or on edge- Select -Not at allSeveral daysMore than half the daysNearly every dayNot being able to stop or control worrying- Select -Not at allSeveral daysMore than half the daysNearly every dayPreviousNextCurrent SupportsLet's briefly look at current supports, medication, and reports.Currently taking prescription medication for your OCD symptoms or mental health?- Select -NoYes, for mental healthYes, for ADHDEnter medication name and current dosageHave you seen a mental health therapist within the last 12 months?- Select -NoYesIf you have an OCD diagnostic report, please upload (PDF or DOCX only). If you do not have a digital copy, you can submit the report laterChoose File PreviousNextOCDSpecific QuestionsPlease answer the following 6 questions as pre-screening for OCD servicesDoes your mind often make you do things - such as checking or touching things or counting things - even though you know you don't really have to? - Select -NoA bitA lotAre you particularly fussy about keeping your hands clean? - Select -NoA bitA lotDo you ever have to do things over and over a certain number of times before they seem quite right? - Select -NoA bitA lotDo you ever have trouble finishing your school work or chores because you have to do something over and over again? - Select -NoA bitA lotDo you worry a lot if you've done something not exactly the way you like?- Select -NoA bitA lotDo these symptoms things interfere with your life? - Select -NoA bitA lotDo you try to stop these symptoms? - Select -NoA bitA lotPreviousNextWhy do you think you might have OCD?PreviousNextAppointment Commitment FeeFee: $40.00Pay with Card (Stripe)Submitting your Intake RequestPlease read the following carefully Submitting this form will forward my information to STG Health Services Inc. I understand that incomplete forms or inquiries irrelevant to OCD services and requesting an intake appointment will be discarded. I understand that I will receive a text message and an email about making an intake appointment. I understand that submitting this form does not provide crisis management or urgent mental health support. If I need help now, I will call the Health Line 811 immediately or contact 911. All marketing and spam submissions will be deleted. I agree and understand the above statements Previous Request Priority Intake