Phyllis M. Richardson, Ph.D., Licensed Psychologist


These forms can be downloaded, filled out by hand, and brought to your appointment.

Office Policies
Appointment policy, fees, and how to contact me.
Office Policies (pdf form)

Informed Consent for Treatment and Evaluation
Rules of confidentiality, use of health insurance, and clients' rights.
Informed Consent (pdf form)

General Information
Requests basic information from new clients, including contact information, relationship status, employment information, and insurance data.
General Information (pdf form)

Presenting Problems
Provides you the opportunity to detail the problems you are experiencing, including family and trauma history, interpersonal information, and previous mental health treatment.
Presenting Problems (pdf form)

1112 NE 21st Ave., Suite. #5
Portland, OR 97232
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