Hoarding Support Assessment
Help us understand your needs and experiences related to hoarding so we can offer appropriate support.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is your current living situation?
*
Living alone
With family
With roommates
Other
How would you describe the severity of clutter in your home?
*
Minimal
1
2
3
4
5
6
7
8
9
Extreme
10
1 is Minimal, 10 is Extreme
Please indicate how often you experience the following behaviors:
*
Rows
Never
Rarely
Sometimes
Often
Always
Difficulty discarding items
1
2
3
4
5
Acquiring items you don't need
6
7
8
9
10
Feeling distressed by clutter
11
12
13
14
15
Avoiding visitors due to clutter
16
17
18
19
20
Feeling overwhelmed by possessions
21
22
23
24
25
How much does hoarding impact your daily life and relationships?
*
No impact
1
2
3
4
5
6
7
8
9
Severe impact
10
1 is No impact, 10 is Severe impact
Have you ever sought help or support for hoarding before?
*
Yes
No
If yes, please describe the type of support or treatment you received.
Are there any safety concerns (such as blocked exits, fire hazards, or unsanitary conditions) in your living space?
*
Yes
No
Not sure
How ready do you feel to make changes regarding your hoarding behaviors?
*
Not ready
1
2
3
4
5
6
7
8
9
Very ready
10
1 is Not ready, 10 is Very ready
What kind of support are you interested in? (Select all that apply)
*
One-on-one counseling
Group support sessions
Educational resources
Home visits/organizing help
Other
Please share any additional information or concerns you think are important.
Submit Assessment
Should be Empty: