Common Contracts
1 similar Medical Lien Agreement contracts
MEDICAL LIEN AGREEMENTMedical Lien Agreement • September 1st, 2021 • Michigan
I, ___________________________________________ (“Patient”) do hereby authorize and direct my attorney to pay directly to _______________________ (“Provider”) such sums of monies as may be due and owing to them arising out of the __________ motor vehicle accident for:
