Common Contracts
1 similar Medical Lien Agreement contracts
MEDICAL LIEN AGREEMENTMedical Lien Agreement • January 30th, 2019
The named Patient (“Patient”) desires medical treatment by the named Provider, including all entities and specialists that provide services for, at or through Provider (collectively, “Provider”) for injuries sustained in the above-referenced personal injury incident (“Incident”). Patient has or shall retain the below-referenced Attorney (“Attorney”) to seek compensation (“Litigation”) for the injuries arising from the Incident. At Patient’s request, Provider agrees to treat Patient on a “lien” basis (“Medical Lien”), establishing a debtor-creditor contractual relationship, whereby Patient remains responsible to pay Provider’s bill (“Bill”), but Provider agrees wait to be paid until the conclusion of the Litigation. However, if any provision of this Medical Lien is not strictly complied with by Patient or Attorney, Provider may declare a breach of this Medical Lien agreement, and Patient agrees to then pay the full balance owed Provider immediately; and, if Patient fails to timely pay,
