Contact and Prescreening Form

Thank you for your interest in my specialty practice. Please note, that I am presently prioritizing young adults and millennials seeking treatment for Obsessive Compulsive Disorder with onset within the past 5 years. However, I will consider prospective clients seeking treatment for one or more of the other anxiety disorders described on this site and listed below on this form. While I do work with teens age 17 and older, I am highly selective when considering a prospective client under the age of 18. I do ask that the client themselves complete this form.

Prior to completing this form, it is important to read through the pages describing my approach, the IBA and CBT methods I use as well as the sections describing the condition(s) that match your symptoms. This information will be needed to thoroughly answer the questions that follow. It can be helpful to have those pages opened in separate tabs, when working on this form. 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 issues of diversity, social and racial justice, reproductive rights, gender identity choices are woven into my person and work. Racism, misogyny, xenophobia, homophobia and anti-democratic ideology have no place in my practice. If my stance on these issues causes you discomfort in any way, regrettably, I think it best that you explore treatment with another provider.
Pandemic and COVID-19

Although COVID cases and deaths decreased in April, they are now on the rise again with the emergence of BA.2+ and BA.4 BA.5 Omicron variants. My thinking is in line with that of most Virologists and Epidemiologists who believe that vaccination together with mitigation-targeted masking, filtration and rapid testing- remain important. Consequently, I do require that all prospective clients show certificate of double vaccination with booster. While not a requirement, I but would hope that prospective clients continue to mask to protect that vulnerable when in public spaces-such as stores and supermarkets.

At the moment, sessions are conducted either remotely via video or in-office with masks or outdoors. I have resumed in-person exposures to treat specific phobias and agoraphobia as well as real-time driving exposures with masks for HW agoraphobia. Virtual reality treatment for fear of flying and phobias can be done remotely or in-office

Country of Residence

Occupation

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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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 accepted. 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