Health Services Forms

Easily prepare your patient consent forms, medical liens and administrative documents with these downloadable Health Services Forms.

Our template forms are used by:

  • medical clinics and hospitals,
  • chiropractors and massage therapists,
  • home care providers,
  • patients and staff in health care facilities.

The templates can be customized with the logo, address, phone/fax numbers, email and information about your office, clinic or facility.

View as Grid List
Sort by
Display per page

Arizona Patient Consent and Doctor's Lien

Make sure your bills get paid. Have your patients sign this Arizona Patient Consent and Doctor's Lien at the time of treatment.

  • The patient consents to treatment and authorizes release of all medical information with respect to the patient's claim regarding the accident or injury for which the patient is being treated.
  • The patient agrees to be personally liable for paying the medical provider's fees regardless of the outcome of the patient's claim.
  • The patient gives the medical provider an irrevocable lien on any settlement or damages awarded to the patient and directs his/her attorney to satisfy the lien out of those proceeds.
  • The patient will notify the medical provider if he/she retains new legal counsel.
  • Buy the form once, and it's yours to use as often as you require.

Get this Arizona Patient Consent and Doctor's Lien form today, and enjoy the peace of mind from knowing that you'll receive payment for your services.

$12.49

Arkansas Medical Release and Irrevocable Lien

AR health care providers, make sure you get paid for your services by having patients sign this Arkansas Medical Consent, Release and Irrevocable Lien form at the time that treatment is provided.

  • The patient consents to treatment and authorizes release of all medical information.
  • The patient agrees to be personally liable for paying the medical provider's fees and is responsible for making all financial arrangements for payment of the account.
  • The patient assigns any Medicare or Medicaid benefits to the medical provider.
  • The patient gives the medical provider an irrevocable lien on any settlement or judgment proceeds awarded to the patient and authorizes his/her attorney to satisfy the lien out of those proceeds.

Feel secure knowing that your bill will be paid. Get the Arkansas Medical Consent, Release and Irrevocable Lien Form today.

$12.49

California Patient Fee and Lien Agreement

Don't take the risk that your bills for medical services will not be paid. Get your patients to sign this California Patient Fee and Lien Agreement form before you provide treatment.

  • The patient agrees to be personally liable for paying the medical provider's fees and is responsible for making all financial arrangements for payment of the account.
  • The patient gives the medical provider an irrevocable lien on any settlement or damages awarded to the patient and directs his/her attorney to satisfy the lien out of those proceeds.
  • This is a reusable legal form. Buy it, download it, and it's yours to use as often as you require.

The California Patient Fee and Lien Agreement is an easy-to-use template that can be customized for your clinic or office.

$12.49

Caregiver Service Agreement

Do you need an in-home caregiver to provide assistance for you or a loved one? Use this template Caregiver Service Agreement to hire someone to fulfill that role.

  • The Agreement can be used to provide support for an elderly person or for anyone else who requires assisted living services in order to keep living in their own home.
  • The caregiver can be anyone, including a family member.
  • The contract template lists the typical services that a caregiver would provide. You can delete those services which are not applicable.
  • The compensation clause contains two options, one for a set rate (hourly, weekly or monthly) and one for a prepaid lump sum amount.
  • The form also includes a list of restrictions and obligations which the caregiver must comply with, such as not interfering with or trying to influence the client's decisions, and not accepting gifts or money except as provided in the Agreement.
  • This is a generic legal form that does not make specific references to the laws of any country.

Add the Caregiver Service Agreement to your cart, check out and pay for it, then download the form to your computer or tablet.

$17.99

Chiropractic Patient Authorization to Release Medical Records

Get this Authorization form signed in order to get access to a patient's medical records for purposes of chiropractic treatment.

  • The patient's doctor or other medical service provider is directed to release the patient's medical records to the chiropractor so that treatment can begin.
  • This is a generic patient authorization form that can be used anywhere.
  • You can easily customize the form with your logo, office address and phone number.

Pre-printed forms are expensive. Download the Patient Authorization Form and use it as often as you like - no more restocking costs, print as many as you need.

$2.29

Chiropractic Patient Blanket Authorization Form

Chiropractors, obtain a general authorization from a patient with this downloadable Chiropractic Patient Blanket Authorization Form.

  • When the patient completes the form, he / she is giving a general 'blanket' direction to any and all medical, paramedical and healthcare service providers.
  • The patient authorizes these service providers to release to the chiropractor whatever information they may have on file with respect to injuries the patient has sustained and the treatment or care provided.
  • The chiropractor is authorized to use this information for treatment purposes.
This Chiropractic Patient Blanket Authorization Form can be easily edited and customized to fit your business needs.
$2.29