Doc2Doc Confidential Messaging

If you would like feedback on your patient’s progress in our program, please have your client sign a release of information forms and send it to us.

For your convenience, we have a standard Release of Information Forms available for your use. After we have received the signed Release of Information, we would be happy to share all clinical data with you.
Holman Therapist Release of Information Form
Medical Doctor Release of Information Form

Fields marked (*) are required

Doctor’s Name:
*
Doctor’s Phone Number:
* (xxx) xxx-xxxx or xxx-xxxx
Fax:

Email Address:
*
Patient’s Name:
*
Patient’s Employer:

Diagnosis:

Request/Question/Comments:

A psychiatrist will give you a call within 24-hours to discuss the above case. If you would like to speak with a doctor immediately please call 800-321-2843.

The Holman Group
Attention: Health Advocate
9451 Corbin Avenue, Suite 100
Northridge, CA 91324
Phone: 800-321-2843
Fax: 818-704-9339