Health Services Forms

Make sure you get paid for medical services rendered to a patient with this Connecticut Doctor's Lien and Patient Consent form.

• Patients should sign this form before you provide treatment.
• The patient authorizes the facility to release medical information about the injury and treatment, for purposes of the injury claim.
• The patient gives the medical provider an irrevocable lien on any settlement or damages awarded to the patient and directs his/her attorney to satisfy the lien from those proceeds.
• The patient will be personally liable for paying the health care provider's fees if there is no settlement or if it's insufficient to pay the medical bills.
• The patient will notify the medical provider if he/she retains new legal counsel.

Don't wait for settlement to secure repayment of your bills. Do it now with this Connecticut Doctor’s Lien and Patient Consent Form.

Prepare a business plan for a dentist's office with this fully customizable Dental Office Business Plan template.

• The purpose of the Business Plan is to obtain a start-up loan which will be used to buy equipment and supplies, lease office space, and hire staff for the dental practice.
• The Business Plan includes:
  • A market analysis and marketing strategy for promoting the dental services offered by the dentist's office.
  • A financial model with pro formas.
  • A Confidentiality Agreement to protect your proprietary information, such as financial data.
  • Instructions in each section to help you complete the document.
• Available in MS Word format and totally editable to fit your specific circumstances.

Offer a candidate a house staff position at a hospital in the United States with this Letter of Intent / Employment Offer template.

• The employee must obtain a State medical license or intern and residency license before beginning work.
• The employee must successfully undergo drug and criminal background screening.
• The Medical Center will provide malpractice insurance.
• Health care insurance, life insurance and disability insurance are available through the Center's insurers.
• House staff will be reimbursed for parking fees by means of an annual cash benefit.
• Moonlighting is discouraged but not prohibited. The employee's malpractice insurance does not extend to any outside employment.
• This is a fully editable MS Word document.
• Drafted to be used only in the United States.

Don't be a victim. Read Fighting Back: Every Woman's Guide to Survival and learn how to defend yourself against attackers.

This 66-page self defence guide was written by Helene Crane, a 14-year police force veteran. It will teach you how to stay safe, and practice the author's step-by-step illustrated methods to defend yourself against armed and unarmed attackers:

• Learn how to defend against attacks from the front and from the rear.
• Learn how you can turn everyday objects into defensive weapons.
• Discover ways to deal with the emotional and physical aftermath of an assault.

Fighting Back: Every Woman's Guide to Survival is available in PDF format and can be downloaded to Kindle, Sony Reader or other e-readers.

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.

Do you treat patients who have been injured by accident or third parties. Have them sign this Illinois Doctor's Lien and Patient Consent Form at the time of treatment.

• The patient gives his/her consent for the treatment and authorizes the medical practitioner to release any information required to conduct the patient's injury claim.
• Regardless of the outcome of the claim, the patient will be personally liable for paying the medical bills.
• The doctor has an irrevocable lien on any settlement or damages awarded to the patient. The patient's lawyer is instructed to satisfy the lien out of the settlement proceeds.
• The patient must give notice if he/she hires a different attorney.
• Intended for use only in the State of Illinois.

Keep Your Nurses and Health Care Professionals for Life is a downloadable 210-page book by Brian Lee, CSP, based on his popular seminars.

• The book delves into the medical profession and gives tips on how to keep our healthcare professionals in Canada and give life back to the profession.
• Discover the 4 imperatives of how to inspire, retain, motivate and empower patient focused nurses and health care professionals.
• Learn more about significant issues such as staff retention, staff empowerment, continuing education and inter-office relationships.
• Keep Your Nurses and Health Care Professionals for Life is a downloadable e-book which is available in PDF format.

Don't gamble with your patient invoices. Have your patients sign this Massachusetts Doctor's Lien and Patient Consent Form at the time treatment is provided.

• The patient consents to treatment and authorizes the facility to release his/her medical information for purposes of the patient's injury claim.
• The patient will be personally liable for paying the medical provider's fees whether or not the claim is successful and damages are awarded.
• The patient gives the medical provider an irrevocable lien on any settlement or damages awarded to the patient and directs his/her attorney to satisfy the lien out of those proceeds.

You can use this Massachusetts Doctor's Lien and Patient Consent form over and over again. Download it and customize it for your business.

All information collected by a medical office is confidential. Have all of your staff sign this Employee Pledge of Confidentiality.

• In order to comply with privacy laws, all personnel employed in health services positions must pledge in writing to keep all patient information confidential.
• This form is downloadable, editable and easy to use.
• Customize the form by adding your office's logo, and print off copies to use as a hand-out for new employees and practitioners to sign.
• This free form is available in MS Word format.

Secure the payment of your patient invoices with this Missouri Doctor's Lien and Patient Consent form.

• Patients receiving treatment for third party injuries (including on-the-job accidents) should sign this agreement before treatment begins.
• The patient consents to the treatment and authorizes the release of his/her medical information as required to document the patient's injury claim.
• The patient gives the doctor an irrevocable lien on any settlement or damages awarded, which will then be used to pay the lien.
• The patient agrees to be legally liable for paying the full amount of the health care provider's fees, regardless of the outcome of the claim.

Stop worrying over whether your bills will get paid. Get the Missouri Doctor's Lien and Patient Consent form today.