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Georgia Patient Consent and Medical Lien Agreement

Make sure injury patients pay their bills by having them sign this Georgia Patient Consent and Medical Lien Agreement.

Why should I use a Medical Lien Agreement?

A medical lien (also called a doctor's lien) ensures that your bills will be paid from any amounts eventually recovered by the patient. This gives medical service providers the flexibility to provide those services without up-front billing, knowing that the lien will be paid from the recovery proceeds.

Lien Rights

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. Notwithstanding any settlement of the claim, the patient remains personally responsible for paying the fees.

Patient Consent

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.

Format and Scope of Use

This is a reusable legal form in MS Word format. 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 Patient Consent and Medical Lien Agreement is intended for use only in the State of Georgia.

Document Type: Microsoft Word
Last Updated: 17-December-2025
SKU: 128
$7.99
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