Contact and Pre-screening Form

Thank you for your interest in my specialty practice. Please note, that I am presently prioritizing those seeking treatment for repugnant sexual, harm obsessions and doubting and checking sub-type of OCD with onset within the past 5 years. While I do work with teens 18 and older, I am highly selective when considering a prospective client under the age of 21. I do ask that the person seeking help complete this form themselves. Form filled out by family members will not be considered

Before proceeding, it is important to read through the pages describing my approach as well as the sections describing the condition(s) that match your symptoms. This information will be needed to answer the questions that follow. It can be helpful to have those pages opened in separate tabs. Based on your responses, I will determine whether we would move forward to the next step of setting up a brief telephone screening.

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Please note that sensitivity to diversity, inclusion, social justice, reproductive rights, gender equality and non-binary gender identify are woven into my person and, at times, into my work.
Pandemic and COVID-19

Although COVID19 cases and deaths have decreased over the past 6 months, this pandemic, unfortunately, is still with us and consequently, sessions are conducted remotely via video or in-office with, at least, one-way masking. I do require that all prospective clients be vaccinated

Country of Residence

Employment and Occupation

COVID Precautions [Response Required for both columns]

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I am seeking treatment for one or more of the following types of OCD

I am seeking treatment for one or more of the following anxiety disorder or conditions

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Impact of pandemic and political/international events

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Please check any of the following conditions, behaviors or circumstances that apply

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Below is a list of health insurance plans I accept in Massachusetts. Please check if you are covered by one of these or if you will be paying out-of-pocket.

Please indicate how you will be paying for treatment

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© 2022 Robert Safion, LMHC

Treatment of Obsessional Spectrum Anxiety

6 Harris Street, Newburyport, MA 01950