Patient Payment Plan Agreement

June 13, 2012

Here's a simple form to download and use at your medical practice to set up a payment plan with patients.

Sometimes, it is helpful to set up a payment plans with your patients for your services. Here's a handy tool to help you get started and here is some additional guidance from George Conomikes of Conomikes Associates.


Download the form here as a Word document and here as a PDF file.