California Patient Fee and Lien Agreement

$12.49

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.

Download Type: Microsoft Word
SKU: 8353
Last Updated: 14-Apr-2016