Template for Prompt Pay and/or Pre Pay and Eligibility for Medical Indigence and Waiver of Co-Pays

This form includes clauses for pre pay, prompt pay and waivers for financial hardships.

One of the most common misconceptions that many therapists have is that it is okay to have many fee schedules – one for in network, one for out of network and one for cash paying patients. This template will serve to legitimize and document these scenarios and help you maintain best practice in your back office management. It has been reviewed by an attorney
It is editable so that you can include your practice name etc.