Healthcare Lien Forms

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Customer agrees that the liability of Dar-Liens, Inc., its agents and employees, in connection with services hereunder to the Customer and to all persons having contractual relationships with them, resulting from any acts, errors and/ or omissions, whether negligent or otherwise, of Dar-Liens, Inc., its agents and/or employees is limited to the total fees actually paid by the Customer to Dar-Liens, Inc., for those services.

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Patient Information

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Attorney Information

Additional Comments

We have read this complete Authorization and Contract and agree to all the stipulations contained therein, and agree to pay all legal fees should there be any breach of contract, or if I/we supply any forms and or data for use by anyone else not under contract with Dar-Liens, Inc.


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