California Patient Fee and Lien Agreement

Don't take the risk that your bills for medical services will not be paid. Get your patients to sign this California Patient Fee and Lien Agreement form before you provide treatment.

• The patient agrees to be personally liable for paying the medical provider's fees and is responsible for making all financial arrangements for payment of the account.
• 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.
• This is a reusable legal form. Buy it, download it, and it's yours to use as often as you require.

The California Patient Fee and Lien Agreement is an easy-to-use template that can be customized for your clinic or office.