Prepare a Release of Alleged Malpractice Claims against a physician with this template form for the United States. The release should be obtained from the patient upon payment of an agreed settlement amount from the physician. The patient releases the physician from any claims of alleged malpractice relating to complications arising or resulting from treatment and/or surgery in connection with an illness or other medical condition.

This is a USA legal form in MS Word format, and is fully editable to fit your particular circumstances.