As a patient of SonderMind, you have the right under the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA) to access your medical Protected Health Information (PHI). You have the right to receive a copy of your medical record. SonderMind will not charge you for providing a copy of your medical record electronically. You can have your medical record sent to yourself or to someone else. Please use this form to tell us where you would like us to send your medical record.

This form is intended to be completed by the client, the individual receiving therapy services from a SonderMind therapist, or their personal representative (e.g. a parent, legal guardian, etc.). With limited exceptions, SonderMind does not fulfill requests for medical records from third parties. If you are a third party, please send the link to this form to the client, or their personal representative, and ask them to complete the form.

This form is HIPAA-compliant and your responses are encrypted. SonderMind uses Google Workspace and has a business associate agreement with Google LLC. None of the information you enter in this form will be shared with anyone other than SonderMind. 

Receipts/billing statements are available in the client portal. You may download receipts by accessing the 'Billing' tab. Receipts reflect client payments and refunds. For information on insurance payments, please obtain an explanation of benefits from the client's insurance carrier.