Which document presents a statement about a new patient's payment responsibility?

The patient information form serves as a critical document that collects essential details about a new patient, including their personal information and financial responsibilities related to payment for services. This form often includes information regarding insurance coverage, deductibles, copayments, and the patient’s acknowledgment of their financial responsibilities, making it the most appropriate choice for presenting a statement about a new patient's payment responsibilities.

While the patient ledger tracks financial transactions and balances over time, it does not primarily present initial payment responsibility details. Preauthorized credit card forms are focused more on securing payment methods rather than outlining responsibilities. The encounter form, although it is used to document services provided during a visit, typically includes coding for billing but does not specifically present a statement about payment responsibilities for new patients. Therefore, the patient information form is the most relevant document for this purpose.