Texas Patient Consent and Doctor's Lien

Secure payment of your medical fees by getting your patients to sign this Texas Patient Consent and Doctor's Lien Agreement before treatment begins.

• The patient authorizes the doctor / hospital to release any information about his/her injury and treatment for purposes of the personal injury claim.
• Regardless of the outcome of the injury 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.
• Intended for use only in the State of Texas.