Forms for Your First Visit

Below are the forms you or your child will need for your first appointment with Dr. Randy Kulman at South County Child and Family Consultants. Please print out and complete beforehand to bring with you to your visit. 

Click any of the forms below to download a printer-friendly copy :

Background Questionnaire   |   Download (.pdf)   |

Patient Information   |   Download (.pdf)   |

Confidentiality Agreement   |   Download (.pdf)   |

Fee Agreement   |   Download (.pdf)   |

Consent for Treatment   |   Download (.pdf)   |

Authorization of Release   |   Download (.pdf)   |

Protocol for Evaluation   |   Download (.pdf)   |

HIPAA – Privacy Practices   |   Download (.pdf)   |

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