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    Georgia Patient Consent and Medical Lien Agreement

    $6.29

    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.
    Download Type: Microsoft Word
    Last Updated: 23-February-2021
    SKU: 128