Products tagged with 'patient consent form'

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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 treatment or care provided.
The chiropractor is authorized to use this information for treatment purposes.
This form is available in MS Word format and can be easily edited and customized to fit your business needs.

$2.29

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.
Available in MS Word format.

$2.29

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 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.
The patient will notify the medical provider if he/she retains new legal counsel.
Buy the form once, and it's yours to use as often as you require.
Intended for use only in the State of Arizona.

$12.49