Prospective Client Screening

10 Questions | HIPAA Compliant

Please correct the errors described below.

What is your name?

What condition would you like help with?

OCD & Related Disorders Anxiety Stress Tech-Focused Compulsive Behavior (internet/smartphone addiction) Other

Are you seeking help for yourself or someone else?

Self Child Family Patient

Would you like to be seen in person or via Telehealth?

In person office- Ventura, CA Telehealth- I live in CA Hybrid/Flexible- I live in CA Other

How did you hear about this therapy practice?

IOCDF Psychology Today Google Search Postpartum Support International ABCT Provider Referred Insurance Directory Other

Please write in the name of your health insurance. Write N/A if you wish to pay privately:

Are you a member of Gold Coast Health Plan?

Yes No

Please list the best email and phone number to contact you.

Would you like to speak by phone for 10-15 minutes prior to scheduling? Free consult calls are primarily for the purpose of discussing logistics and answering questions about treatment approach. Teva is not able to give clinical advice or interpretations of symptoms over the phone.

Yes, please call me. No, let's communicate by email.

Do you have any specific questions, or is there anything else you'd like to share here?

Your information will be encrypted.

Teva Johnstone, LCSW

Licensed Therapist & OCD Specialist

California Licensed Clinical Social Worker in private practice specializing in the treatment of OCD and anxiety disorders using Exposure-Based Therapies. In person therapy in Ventura, near Santa Barbara, Ojai, and Camarillo, and online therapy throughout the state of California serving Los Angeles and the Bay Area.

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