For your benefit and your patients', record financial arrangements in writing with this simple form.

F202-I - Financial Arrangements, with imprint


Document financial agreements of 4 payments or fewer and no finance charge with this concise, 2-ply, carbonless form. Patient and witness signature reinforce commitment. (For more than 4 payments or for any arrangement with a finance charge, use the Truth in Lending Statement.) Each package contains 250 sheets. There is a $70.00 fee for new imprint set-ups, existing imprint revisions and type resets.

Price: $76.00
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  F202 - Financial Arrangements, plain - For your benefit and your patients', record financial arrangements in writing with this simple form.


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  F202-I - Financial Arrangements, with imprint - For your benefit and your patients', record financial arrangements in writing with this simple form.
  F203-I - Truth-in-lending, with imprint - Financial agreements that have more than 4 payment installments or that contain a finance charge legally must comply with Truth in Lending regulations.
  F207-I - Superbill/Routing Slip, with imprint - This speedy, 3-ply, carbonless form gives you a patient receipt, attending dentist's statement for insurance purposes and an office audit copy of procedures performed ALL IN ONE!
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  F202 - Financial Arrangements, plain - For your benefit and your patients', record financial arrangements in writing with this simple form.
  F203 - Truth-in-lending, plain - Financial agreements that have more than 4 payment installments or that contain a finance charge legally must comply with Truth in Lending regulations.
  F207 - Superbill/Routing Slip, plain - This speedy, 3-ply, carbonless form gives you a patient receipt, attending dentist's statement for insurance purposes and an office audit copy of procedures performed ALL IN ONE!
  F209 - Insurance Claim Tracer, plain - Save time following up on unpaid claims with this 2-ply form designed to cover the most common inquiries in an easy checklist format.

 

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