Re: Independent Private Practice

[Guest guest]

Attached is a sample of a financial hardship that we are currently using. It

has been

helpful to us and provides excellent documentation should we need it down the

road. Hope it is helpful!!

Sandy

P.S. This form also helps weed out those patients that want us to write-off

their

portion of the bill, but are not truly in a position of hardship. In

addition, it complies

with insurance companies that require proof as to why we are not collecting

from their policyholders correctly.

Good Luck!