Georgia Patient Consent and Medical Lien Agreement
Secure the payment of your bills for medical services by having your patients sign this Georgia Patient Consent and Medical Lien Agreement before treatment begins.
- The patient authorizes the medical practitioner to release any information about the accident or injury being treated for purposes of the patient's injury claim.
- Notwithstanding any settlement of the claim, the patient is personally responsible for paying the fees.
- The medical provider has an irrevocable lien over any amounts awarded to the patient. The patient's attorney is directed to satisfy the lien out of the settlement funds.
- This is a reusable legal form. Once you've purchased it, you can use it as often as you like.
- The template can be customized for your specific business needs.
- This form is intended for use only in the State of Georgia.
Last Updated: 23-February-2021