International OCD Foundation (IOCDF)
 
Treatment Provider Enrollment Form

 

 

This information will be posted on the IOCDF website in our Treatment Provider Database. Note: Fields denoted in bold will be part of search criteria (e.g. a website user can search providers based on geographic location, specialty areas, participation in at BTTI, etc.)

Is this for a new listing or to update an existing one?  

1. New
2. Update

 

Name,Degree: (example: John Smith, PhD)

Title (if applicable): (example: Director of Psychological Services)

Work Street Address:  

 City:  State/Province:

 Zip/Postal Code:

 Country:

Work Phone: Fax:

Email:

Website:

Do you want your email address to be included in listing?:

1. Yes
2. No

Please check all that apply:

 Populations:

1. Children
2. Adolescents
3. Adults

 Payment Options:  

1. Self-Pay Only
2. I accept some private insurances
3. I accept Medicare
4. I accept Medicaid
5. I offer a sliding fee

 
Treatment Strategies:   

1. CBT
2. ERP
3. Prescribe medication
4. Habit Reversal
5. Talk Therapy
6. Family Therapy
7. Group Therapy
8. Home Visits

 
Specialty Areas (in addition to general OCD Treatment):  

1. Perfectionism
2. Scrupulosity
3. Violent/Sexual Obsession
4. Hoarding
5. BDD
6. Trichotillomania
7. Skin Picking
8. Tics/Tourettes

 
Additional Languages:  
 
 
Have you graduated from a BTTI (Behavior Therapy Training Institute) through the IOCDF?:
This means you attended all three days of the BTTI and finished your three consultations with your faculty group leader.  

1. Yes
2. No

 
Have you ever been an IOCDF Behavior Therapy Training Institute faculty member?:  

1. Yes
2. No

 
(Optional)

A description of your training, credentialing or experience (e.g., number of years treating OCD patients) in treating OCD and/or OCD Spectrum Disorders. This could include post-doctoral training, workshops, supervision with a senior therapist in the field, etc. Please do not list the names of your supervisors – instead, you may list their institutional affiliations or if they are current members of our Scientific Advisory Board. This must be limited to 100 words or less.
 
   

A narrative describing your services/practice/clinic (e.g., percentage of your practice that is for OCD and/or OC Related disorders, total number of individuals with OCD and/or an OC Related Disorder that you have treated). This must be limited to 100 words or less.