The Austin Center for the Treatment of
Obsessive-Compulsive Disorder PLLC

Child Forms

Everyone should download and read the following four forms. You can print them out if you like, but it's not necessary.
 
            ~Limits of Confidentiality
            ~Privacy Practices (HIPAA)
            ~Directions & Map to AustinOCD
            ~CYBOCS Instructions
 
Everyone should download, print, and fill out the following four forms:
 
            1 Client Information (Child/Adolescent)
            2 Child Checklist of Characteristics
            3 Child OC Symptom Checklist
            4 CYBOCS
 
If your child has had previous treatment from a psychologist, psychiatrist, counselor, etc., download the following form, print as many copies as you need, and fill them out. Use your judgement in deciding which therapists might be useful for us to talk to.
 
            Authorization for Release of Information - Outpatient
 
If your child has ever had a psychiatric hospitalization, download, print, and fill out the following form. (If there have been multiple hospitalizations, please fill out a separate copy for each one.) This will authorize their releasing records about your child's hospitalization to us.
 
            Authorization for Release of Information - Inpatient
 
If you live far from Austin, or if you live closer but are interested in Intensive Outpatient Treatment, download and read the following two forms. You can print them out if you like, but it's not necessary.
 
 
            ~Hotel List
            Contract for Intensive Treatment
 
The sample contract is just for your information at this point and does not need to be filled out yet.
 
Returning the forms to us
 
If you are coming to AustinOCD for regular, outpatient treatment (typically weekly sessions), you can just bring the forms with you to your initial session. (If you prefer, you can send them to us as indicated below.)
 
If you are coming to AustinOCD for Intensive Treatment, please return the forms you have filled out, either by
            Fax to 512 637-5578; OR
            Snail mail to AustinOCD, Highway 290 East, Suite 300, Austin, TX 78723; OR
            Scan them into your computer (preferably as a pdf) and email them to brooke@austinocd.com.
 

 


Click here for Adult Forms