Support Group for Teens with OCD
Jacob Center for Evidence-Based Treatment
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Child Participant's Name
Child Age
Child Date of Birth
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Parent's Names
Parent's Phone Number(s)
Parent's Email Address(es)

Address (Group participants must reside in the state of Florida): 

How did you hear about this support group?:

Is your child currently under the care of a mental health professional? If so, please indicate who.

Notes (if there is anything else you would like to add):
Thank you for your interest in our support group for teens with OCD! We will be in touch.
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