Wisconsin Doctor's Lien and Patient Release

Make sure your fees for medical services get paid. Have your patients sign this Wisconsin Doctor's Lien and Patient Release.

• You can claim a lien for the fees for medical services provided to a patient with respect to accidents or injuries caused by third parties (including injuries sustained on the job).
• The patient must give his/her consent for the release of any medical information required for purposes of the patient's injury claim.
• The medical practitioner has an irrevocable lien on any settlement or damages awarded. The amount of the lien will be paid from any damages or settlement amounts paid to the patient.
• Regardless of whether or not the patient's injury claim is successful, the patient remains legally liable for paying the full amount of the fees.

Don't risk not getting paid. Download this Wisconsin Doctor's Lien and Patient Release Form for your facility.