ACCOUNT INFORMATION - NEW PATIENT FORM SERIES

It is good risk procedure to keep financial records seperate from diagnostic and patient information. The Account Information form organizes type of case, insurance coverage, and insured's information. The back of the form contains releases necessary to do insurance business on the patient's behalf and a seperate section to thoroughly document insurance verification as it applies to your services.

PAD OF 100 - 8.5" X 11" - 2 SIDED