Massachusetts Doctor's Lien and Patient Consent

Don't gamble with your patient invoices. Have your patients sign this Massachusetts Doctor's Lien and Patient Consent Form at the time treatment is provided.

• The patient consents to treatment and authorizes the facility to release his/her medical information for purposes of the patient's injury claim.
• The patient will be personally liable for paying the medical provider's fees whether or not the claim is successful and damages are awarded.
• 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.

You can use this Massachusetts Doctor's Lien and Patient Consent form over and over again. Download it and customize it for your business.