Please completed the following forms, save on your computer and have available for the first session. Once you save have filled out the form, it is essential that you print to a PDF file with a different name to save your responses. The Telepsychology Consent Form must be printed out, completed and signed. If you can scan the completed and signed form, it can be submitted at the time of the session. If not, you will need to mail it to:

Rory Fleming Richardson, Ph.D.

P.O. Box 128 Seymour, Missouri 65746

Thank you

PATIENT INFORMATION.

ADULT BACKGROUND QUESTIONNAIRE

CHILD BACKGROUND QUESTIONNAIRE

TELEPSYCHOLOGY CONSENT FORM