When you put patients on a payment plan, it's a good idea to codify the agreement with a written and signed form. You don't want the same person walking back in for an appointment and saying "payment plan? I don't know nothin' about no stinkin' payment plan!"
To simplify things, I'm reposting a sample payment plan agreement form based on a form actually being used by a real practice. You can tweak the form to your heart's content because it's simply a Word file.
Please note that the physicians and providers listed on the sample form -- which includes one "Grant Huang" -- are not real clinicians in any way, shape or form.
Here's a link to the Hot Documents folder in the PBN Library. You'll find the sample letter listed under the contents, near the top.
Many readers enjoyed my story on how to best use patient payment plans. Several had trouble accessing the sample, so use the link above to make things easier.
While you're at the PBN Library, feel free to check out our other helpful tools and documents!