For the purposes of this document, “the patient” refers to the person(s) receiving services at Hoffman Psychiatric Services and “Dr. Hoffman” refers to Dr. Sigalit Hoffman providing said services.
You are responsible for any and all charges incurred for rendered services withHoffman Psychiatric Services including any monies due and owing under your health insurance plan (i.e., copayments and unmet deductibles) or other third-party payor (i.e., Employee Assistance Programs [EAPs]).
I authorize the release and exchange of my confidential information as necessary for the purposes outlined.
Your personal and health information will be kept confidential and handled in accordance with our Privacy Practices and applicable laws.
All patient information is protected in compliance with HIPAA regulations to ensure privacy, security, and confidentiality of your health records.
