Health Services Forms

Make sure your bills get paid. Have your patients sign this Arizona Patient Consent and Doctor's Lien at the time of treatment.

• The patient consents to treatment and authorizes release of all medical information with respect to the patient's claim regarding the accident or injury for which the patient is being treated.
• The patient agrees to be personally liable for paying the medical provider's fees regardless of the outcome of the patient's claim.
• The patie.....

AR health care providers, make sure you get paid for your services by having patients sign this Arkansas Medical Consent, Release and Irrevocable Lien form at the time that treatment is provided.

• The patient consents to treatment and authorizes release of all medical information.
• 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 as.....

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.....

Do you need an in-home caregiver to provide assistance for you or a loved one? Use this template Caregiver Service Agreement to hire someone to fulfill that role.

• The Agreement can be used to provide support for an elderly person or for anyone else who requires assisted living services in order to keep living in their own home.
• The caregiver can be anyone, including a family member.
• The contract template lists the typical services that a caregiver would prov.....

Get this Authorization form signed in order to get access to a patient's medical records for purposes of chiropractic treatment.

• The patient's doctor or other medical service provider is directed to release the patient's medical records to the chiropractor so that treatment can begin.
• This is a generic patient authorization form that can be used anywhere.
• You can easily customize the form with your logo, office address and phone number.

Pre-pr.....

Chiropractors, obtain a general authorization from a patient with this downloadable Chiropractic Patient Blanket Authorization Form.

• When the patient completes the form, he / she is giving a general 'blanket' direction to any and all medical, paramedical and healthcare service providers.
• The patient authorizes these service providers to release to the chiropractor whatever information they may have on file with respect to injuries the patient has sustained and the tre.....

Bring an associate into your chiropractic practice with this template Chiropractor Associate Contract. Provisions of the agreement include:

• Facilities and services to be provided by the chiropractic clinic to the associate;
• Number of hours the associate is expected to work;
• Billings and collections procedures;
• Ownership of and responsibility for patient files;
• The associate will have first right of refusal to buy the chiropractic.....

Claim a lien for medical services to make sure you get paid. Have your patients sign this Colorado Doctor's Lien and Patient Consent at the time that treatment is provided.

• The patient consents to the treatment and authorizes the medical facility to release his/her patient information regarding the accident or injury for which the patient is being treated, for purposes of the injury claim.
• The patient agrees to be personally liable for paying the medical provider's fe.....

Chiropractors, have each new patient fill out this Confidential Health Record and Information Sheet prior to receiving chiropractic treatment.

• personal and medical history,
• job-related injuries,
• current health condition, and
• a patient consent form for chiropractic treatment.

Use this downloadable template form to gather confidential information from patients of a massage therapy clinic.

• All new patients should fill out the form before beginning therapy.
• Patients provide medical and contact information, as well as specific details of any existing condition for which the patient is receiving massage treatments.
• The form can be easily customized to include your office and practice information, logo, hours, etc.
• This is a .....