I am looking forward to working together with you through today’s issues towards a brighter tomorrow.
Please download, print and fill in the forms as requested by my office.
Thank you.
Dr. Richard A. Shulman
Licensed Clinical Psychologist
Lic. # PSY 17982
List of Mind Opener Forms
- Registration Form
- Consent for Treatment
- Consent for Treatment (Joint Custody)
- Payment Consent
- Teletherapy Consent
- Biographical Information Form - Adult
- Biographical Information Form - Child
- Billing Insurance Payment Form
- Missed Appointments Agreement
- HIPAA Privacy Notice
- HIPAA Privacy Rules and Sharing Information
I am looking forward to working together with you through today’s issues towards a brighter tomorrow.
Please download, print and fill in the forms as requested by my office.
Thank you.
Dr. Richard A. Shulman
Licensed Clinical Psychologist
Lic. # PSY 17982
List of Mind Opener Forms
- Registration Form
- Consent for Treatment
- Consent for Treatment (Joint Custody)
- Payment Consent
- Teletherapy Consent
- Biographical Information Form - Adult
- Biographical Information Form - Child
- Billing Insurance Payment Form
- Missed Appointments Agreement
- HIPAA Privacy Notice
- HIPAA Privacy Rules and Sharing Information