Georgia health care providers, make sure you get paid for your services by having patients sign this Patient Consent and Doctor's Lien before providing 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.

This Georgia Patient Records Release and Doctor’s Lien is available as a downloadable MS Word file, which can be easily customized to fit your business. Buy the form once, and it's yours to use as often as you require.