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Original price was: $76.99.$61.59Current price is: $61.59.
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Directs the attorney to pay the doctor out of proceeds of settlement and, if necessary, place a lien against any proceeds.
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Use to collect fees from insurance
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8-1/2″ W x 11″ L
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2-part, white/canary, carbonless; printed in black ink
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250 sets per pack
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Complete the top section in your office, have patient sign, then send to patient’s attorney
| # Up Per Sheet/Page | 1 |
|---|---|
| Lines | 7 |
| Security Features | No |
| Personalization | Yes |
| Package Quantity | 250 |
| Numbered | No |
| Number of Parts | 2 |
| NCR Paper | Yes |
| Media Quantity | 250 |
| Holes Punched | No |
| Binding Type | Glued/Gummed |
| Format | Medical Chart |
| Form Type | Agreements |
| Form Size | 8 1/2" x 11" |
| Customizable | Yes |
| Color | White |
| Carbonless | Yes |
| Brand | Quill |
| Sheet Size | 8 1/2" x 11" |
Be the first to review “Best deal ✔️ Quill Brand Custom General Medical Custom Carbonless 2-Part Doctor Lien Forms, 8-1/2″ X 11″, 250 Sets Per Pack 🎉”
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