OCD Action Helpline Evaluation

What was the reason you contacted OCD Actions Helpline?:

Country of residence

Sex Please select male female

Age (in years)

Are you Please select single married/cohabiting separated/divorced widowed

Are you undergoing any treatment for your OCD? Please select Medication Only Medication + CBT CBT only Exposure Response Therapy Other

How long have you been diagnosed with OCD? (in years)

How many people live in your household?

Do you have any children? If so how many.

What is your work status? Please select employed full time employed part time not working retired other (e.g. student)

In general how would you assess your general health? Please select Excellent Very Good Average Poor Very Poor

In general how would you assess your mental health? Please select Excellent Very Good Average Poor Very Poor

During the past week how much time have you felt clearheaded? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt satisfied with your health? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt good about yourself? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt happy and cheerful? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt independent? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt content? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt able to communicate with others? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt interested in taking care of your appearance? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt able to make decisions? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt able to travel when needed? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt able to deal with problems? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

During the past week how much time have you felt able to take care of yourself? Please select All of the time Majority of the time A good bit of time Some of the time Little of the time None of the time

How satisfied are you with your life at present? Please select Very Satisfied Satisfied Average Not Satisfied Very Unsatisfied

How would you rate your physical health? Please select Very Satisfied Satisfied Average Not Satisfied Very Unsatisfied

How would you rate your Mood? Please select Excellent Good Average Poor Very Poor

How would you rate your work? Please select Excellent Good Average Poor Very Poor

How would you rate your household activities? Please select Excellent Good Average Poor Very Poor

How would you rate your social relationships? Please select Excellent Good Average Poor Very Poor

How would you rate your family relationships? Please select Excellent Good Average Poor Very Poor

How would you rate your leisure time activities? Please select Excellent Good Average Poor Very Poor

How would you rate your sexual drive, interest and performance? Please select Excellent Good Average Poor Very Poor

How would you rate your economic situation? Please select Excellent Good Average Poor Very Poor

How would you rate your living and housing situation? Please select Excellent Good Average Poor Very Poor

How would you rate your overall sense of wellbeing? Please select Excellent Good Average Poor Very Poor

How would you rate your treatment situation? Please select Excellent Good Average Poor Very Poor

Please add any comments here: