15-Day Patient Collection Letter

Close communication with patients is vital to good collections. Send a collection letter after three failed statements, so patients know you mean business.

Practice Name

Practice Address

(Billing Phone Number)



Patient Name

Patient Address

Re: Patient Name

Account #:

Balance Due: $



This is to notify you that your account with us is delinquent. We have not received a response to the statements that were sent to you. The patient balance noted above is the amount that is your responsibility after your insurance company has made payments.

We must receive your payment within 15 days from the date of this letter, to avoid further collection action.

If you need assistance or have any questions, please call between the hours of 8 a.m. and 5 p.m. If you are unable to pay this bill in full, please call and we can discuss setting up a payment plan.


Patient Accounts