* 1. The purpose of this questionnaire is to determine whether the workshop is a good fit for your needs, and to aid planning for the workshop.The information given by you will be held in the strictest of confidence. You will need to be contacted by the workshop leader to confirm your registration, please enter your name and phone number:

* 2. What is your main motivation for taking the hoarding workshop? What do you hope to gain?

* 3. Have you ever sought help for your hoarding problem through self-help books, therapy, or a support group? How did that work out?

* 4. To what degree do you experience emotional distress due to the state of your home?

* 5. How much does your clutter or quantity of stuff get in the way of using the rooms in your home? Please explain.

* 6. To what extent do you currently have a problem with bringing too much new stuff into your home (by collecting free things or buying things)?

* 7. What is your biggest obstacle to discarding (or recycling, giving away, or selling) the excess items in your home?

* 8. When was the last time you worked on getting rid of excess items from your home?

* 9. What types of items do you tend to accumulate? (check all that apply)

* 10. Have you ever had trouble with a landlord, health inspector, or fire inspector due to your hoarding problem? If yes, how long ago and what was the outcome?