Common Contracts

1 similar Assignment of Personal Injury Protection Benefits and Lien Agreement contracts

Assignment of Personal Injury Protection Benefits and Lien Agreement
Assignment of Personal Injury Protection Benefits and Lien Agreement • June 4th, 2021

I, , in order to provide and facilitate the ability of We Care Physical Therapy, LLC (“Provider”) to collect their charges for the services provided to me after my automobile accident (“Charges”)1 directly from the Payor/Insurance Company, agree as follows:

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