Patient Treatment Payment Agreement Form

This is an example of an agreement form that patients should sign when being presented with treatment. Use this form as a guideline to help you develop your own, with the most important parts being that you verify it is legal and binding, and that your patients are signing it each and every time. It is vital to make sure you have signed documents from your patients to make sure to help them know your policies and help when they forget later about the fact your team told them they would be responsible for the balance.