Referral Form from Chiropractor to Physician

Chiropractors can refer a patient to a doctor with this free Physician Referral Form.

  • The Referral Form would be used to refer a chiropractic patient to a new doctor in circumstances where the chiropractor discovers a medical condition that should be treated by a physician.
  • The form has sections for pertinent findings and recommendations.
  • This form can be filled in on the computer or device, or used as a pre-printed form to be filled in by hand.
  • Available in MS Word format.
Document Type: Microsoft Word
Last Updated: 17-February-2025
SKU: 2996
$0.00
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Arizona Medical Lien Agreement

Make sure your bills get paid. Have your patients sign this Arizona Patient Consent and Medical Lien Agreement 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 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