HELP FOR COMPULSIVE HOARDERS

Whatever your crisis, whatever your story, if you or someone you know is suffering from compulsive hoarding, and you would like him or her to be considered for participation on Hoarders, please fill out the form below.

* = required fields

Compulsive Hoarder's Name:*
Hoarder's Age*
Hoarder's Email Address*
Hoarder's Phone Number*
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Hoarder's Address*
Hoarder's Occupation
Applicant's Name*
Relationship to Hoarder*
Applicant's Age*
Applicant's Email Address*
Applicant's Phone Number*
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Applicant's Alternate Phone Number
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Do you live at the same residence as Hoarder?
What is being hoarded?
Does the hoarder consider themselves a perfectionist?
If yes, please give examples
Does the hoarder avoid making decisions?
If yes, please explain
Does the hoarder have a compulsive urge to acquire?
Does the hoarder have an emotional attachment to the items collected?
If yes, please provide examples
Can the hoarder use furniture for the intended purpose?
Can the hoarder prepare food in the kitchen?
Can the hoarder shower/bathe in their bathroom?
Can the hoarder sleep in their own bed?
If no, where do they sleep?
How difficult would it be for emergency personnel to move equipment through the home?
Does the hoarder live by themselves?
If no, how many people currently live in the hoarder's home (including hoarder)?
Are there pets in the home?
If yes, how many?
What kind of pet(s)?
How many friends and family would participate in the program?
Are you currently seeking medical care for OCD/depression/ADHD?
If yes, please write in the condition for which you are seeking help.
Describe how the hoard looks inside and outside the home.
Please describe the crisis being caused by the hoard:
Upload a photo of Hoarder (optional)
Upload a photo of Applicant (optional)
Additional photos in primary living space (optional)
Type the characters below: