tiktok³ÉÈ˰æ

Doctor's Office Financial Agreement Template for United States

Create a bespoke document in minutes,  or upload and review your own.

4.6 / 5
4.8 / 5

Let's create your Doctor's Office Financial Agreement

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

Doctor's Office Financial Agreement

"I need a Doctor's Office Financial Agreement for my small family medical practice in California that includes specific provisions for telehealth services and a detailed payment plan option for uninsured patients, to be implemented by March 2025."

Document background
The Doctor's Office Financial Agreement serves as a crucial document in modern medical practice management within the United States. It's designed to clearly communicate financial expectations and responsibilities between healthcare providers and patients, while ensuring compliance with federal regulations like HIPAA, FDCPA, and state-specific healthcare laws. This agreement becomes necessary when establishing a new patient relationship or updating existing financial policies, and typically covers aspects such as payment terms, insurance billing procedures, cancellation policies, and collection processes.
Suggested Sections

1. Parties: Identification of the medical practice and patient

2. Background: Context of the agreement and relationship between parties

3. Definitions: Key terms used throughout the agreement

4. Financial Responsibility: Patient's obligations regarding payment for services

5. Insurance Information: Details about insurance billing and patient responsibilities

6. Payment Terms: Payment methods, timing, and late payment consequences

7. Signatures: Execution section for all parties

Optional Sections

1. Payment Plans: Optional section detailing terms for installment payments when practice offers payment plan options

2. Collections Policy: Optional section outlining process for handling unpaid accounts when practice uses external collections agencies

3. Cancellation Policy: Optional section specifying terms for appointment cancellations when practice charges cancellation fees

Suggested Schedules

1. Fee Schedule: List of common procedures and their costs

2. Insurance Information Form: Template for collecting insurance details

3. Payment Plan Agreement: Standard payment plan terms and conditions

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈ˰æ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Clauses

























Industries

HIPAA: Health Insurance Portability and Accountability Act - Federal law that protects patient health information privacy and security

FDCPA: Fair Debt Collection Practices Act - Federal law governing how medical debts can be collected and consumer protections in debt collection

TILA: Truth in Lending Act - Federal law requiring disclosure of credit terms and costs to patients when payment plans are offered

ACA: Patient Protection and Affordable Care Act - Federal law establishing requirements for health insurance coverage and patient protections

EMTALA: Emergency Medical Treatment and Active Labor Act - Federal law requiring emergency medical treatment regardless of ability to pay

State Medical Billing Regulations: State-specific laws governing medical billing practices, varying by jurisdiction

State Consumer Protection Laws: State-specific laws protecting consumers from unfair billing practices in healthcare

State Medical Debt Collection Laws: State-specific regulations on how medical debt can be collected and handled

Healthcare Billing Transparency Laws: State-specific requirements for transparency in medical billing and pricing

State Insurance Regulations: State-specific rules governing insurance coverage and billing practices

Medicare Billing Requirements: Federal regulations specific to billing Medicare for medical services

Medicaid Billing Requirements: Federal and state regulations governing Medicaid billing practices

CMS Guidelines: Centers for Medicare & Medicaid Services guidelines for healthcare billing and reimbursement

No Surprises Act: Federal law protecting patients from unexpected out-of-network medical bills, effective 2022

Balance Billing Regulations: State-specific rules regarding balance billing practices and limitations

Credit Reporting Regulations: Federal and state regulations governing how medical debt can be reported to credit bureaus

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

Find the exact document you need

Health Care Contracts

U.S. healthcare contract template incorporating federal and state healthcare regulations, designed for establishing compliant healthcare service relationships.

find out more

Doctor's Office Financial Agreement

A U.S. healthcare contract establishing financial terms between medical providers and patients, compliant with federal and state regulations.

find out more

Medical Report Letter From Doctor

A HIPAA-compliant medical documentation prepared by a U.S. licensed physician detailing patient's condition, treatment, and prognosis for official purposes.

find out more

Medical Non Compete Agreement

A U.S. healthcare sector agreement restricting medical professionals from competing with their former employer within specified parameters, subject to state-specific regulations.

find out more

Healthcare Non Compete Agreement

A U.S. healthcare sector agreement restricting medical professionals from competing with former employers, subject to federal and state regulations.

find out more

Doctor Patient Agreement

A U.S.-compliant legal agreement establishing the terms and conditions of the relationship between healthcare providers and their patients.

find out more

Personal Medical Services Contract

A U.S.-compliant agreement establishing terms for medical service delivery between healthcare providers and patients.

find out more

Medical Director Independent Contractor Agreement

A U.S. healthcare contract establishing terms for physician leadership services as an independent contractor medical director.

find out more

Medical Billing Independent Contractor Agreement

A U.S.-compliant agreement between healthcare providers and independent medical billing contractors, governing billing services and regulatory compliance.

find out more

Custodian Of Medical Records Agreement

A U.S. legal agreement establishing terms for the maintenance and management of medical records in compliance with HIPAA and state regulations.

find out more

Health Care Agreement

A U.S.-governed agreement establishing healthcare service delivery terms and regulatory compliance requirements between healthcare entities.

find out more

Healthcare Arbitration Agreement

A U.S. legal agreement requiring healthcare disputes between providers and patients to be resolved through arbitration rather than court litigation.

find out more

Medical Records Custody Agreement

A U.S. legal agreement governing the transfer and maintenance of medical records between healthcare providers and designated custodians, ensuring HIPAA compliance.

find out more

Health Care Service Provider Agreement

A U.S.-governed agreement establishing terms for healthcare service provision, ensuring regulatory compliance and defining service parameters.

find out more

Medical Payment Plan Agreement

A U.S. legal agreement establishing payment terms between healthcare providers and patients for medical services.

find out more

Medical Self Pay Agreement Form

A U.S. healthcare document establishing direct payment terms between provider and patient without insurance involvement.

find out more

Medical Director Agreement

A U.S. healthcare contract establishing terms for physician leadership services in compliance with federal and state regulations.

find out more

Agreement For Medical Services

A U.S.-compliant contract establishing terms and conditions for the provision of healthcare services between medical providers and patients.

find out more

Medical Confidentiality Agreement

A US-compliant agreement protecting confidential medical information and establishing HIPAA-aligned handling procedures.

find out more

Download our whitepaper on the future of AI in Legal

By providing your email address you are consenting to our Privacy Notice.
Thank you for downloading our whitepaper. This should arrive in your inbox shortly. In the meantime, why not jump straight to a section that interests you here: /our-research
Oops! Something went wrong while submitting the form.

³Ò±ð²Ô¾±±ð’s Security Promise

Genie is the safest place to draft. Here’s how we prioritise your privacy and security.

Your documents are private:

We do not train on your data; ³Ò±ð²Ô¾±±ð’s AI improves independently

All data stored on Genie is private to your organisation

Your documents are protected:

Your documents are protected by ultra-secure 256-bit encryption

Our bank-grade security infrastructure undergoes regular external audits

We are ISO27001 certified, so your data is secure

Organizational security

You retain IP ownership of your documents

You have full control over your data and who gets to see it

Innovation in privacy:

Genie partnered with the Computational Privacy Department at Imperial College London

Together, we ran a £1 million research project on privacy and anonymity in legal contracts

Want to know more?

Visit our for more details and real-time security updates.