Connecticut health care providers, make sure you get paid for your services by having patients sign this
Doctor's Lien and Patient Consent form before providing 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.
This
Connecticut Doctor’s Lien and Patient Consent form is available as a downloadable MS Word file, which can be easily customized to fit your business needs.
