OCD Screen OCD Obsessive-Compulsive Disorder Screening Email to receive your copy (Optional) Confirm Email to receive your copy (Optional) Enter a confirmation email address. Date * Patient Name * DOB * Parent/Guardian Name Does your child (or you) 1. Often obsess over one thing or idea and is unable to “let it go” no matter what? * Yes No 2.a Have to reach a “perfect” level when writing/drawing before moving on? * Yes No 2.b * Does this ever affect completion of school work/task in a timely manner? * Yes No 3. Want things in your room/desk/area a certain way and become extremely agitated if items are moved or changed? * Yes No 4. Have sensory issues around food textures, clothing, etc that affects your day? * Yes No 5. Want strict routines and become irritable if the expected is deviated or changed? * Yes No 6. Have a “my way or the highway” personality and get upset if others do not do things their way? Ex. Follow their scenarios, play with or bother their toys, etc. * Yes No 7. Have certain habits or rituals (such as lining up/sorting items, counting, needing to touch things, etc.) they may need to repeat or do routinely? * Yes No 8. Pick their skin or pull out their hair? * Yes No 9. Hoard objects? * Yes No 10. Need to know everything in advance and in detail or you become agitated and ask questions over and over? * Yes No 11. Get upset if they start to tell someone something and they are interrupted? Do they “need” to complete the thought and start over or get agitated? * Yes No 12. If you answered YES to any of the behaviors mentioned above, do any or all take up at least an hour of your day or cause stress and interfere with daily life or social activities? * Yes No How often are these behaviors noticed? If you are human, leave this field blank. Submit
