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Patient Payment Agreement Form Template

Patient Payment Agreement Form Template

Set up a payment plan with your patients to ensure your practice gets paid on time.

Simplify your workflows

Money can be a tough topic to discuss with patients. Ease the process by using this patient payment plan agreement form template to define your policies and create a payment plan. Formstack offers a HIPAA compliant data collection solution to help you meet all security standards. Collect and store patient signatures as image files, send automated emails to confirm payment, and much more. Easily process insurance, copays, and prescriptions with our HIPAA compliant integrations for Stripe and PayPal. Get started using our patient payment agreement form now!

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