Parent Questionnaire

Please press one of the buttons to download the appropriate PDF questionnaire for your child's age.


Once downloaded, you can:

1) Print off and complete the questionnaire by hand then return it to the referring physician. 

2) Click on this link                                   ( where you can then upload the PDF file, complete it with their free online program, save the completed file back to your computer then e-mail it to the referring physician's office or to my office if they don't have e-mail- in which case, make sure you write down who the referring physician is.


A Teenager's Guide to Life


Free PDF Download Now!

To order a print copy of the book, visit, or 
ISBN # 9780987672407

Dr. F. D. Templeman MD FRCPC

151 Pine Valley Drive

London, Ontario N6J 4M2

I do not provide emergency psychiatric care.  If you have a psychiatric emergency, please go to the nearest ER.
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© 2021 by Dr. F. David Templeman.