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Personal Injury AR Assessment
Please tell us more about your Personal Injury Accounts Receivable.
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ACCOUNTS RECEIVABLE INFORMATION
What is the average age of your outstanding PI AR?
*
Bills 12 months old or less
Bills more than 12 months old but less than 24 months old
Bills more than 25 months old but less than 48 months old
Have you worked with a funding company previously?
*
Yes
No
Currently use one, but am still interested in discussing NHF reimbursement rates
Prior to funding, we must obtain DOL • Bills • Records • Lien/LOP • Attorney contact info • Patient contact info • Auto insurance info • Synopsis of liability. Will you be able to provide this information?
*
Yes, I have all of this information ready to submit for review
Yes, but I am missing some of the details listed above
Yes, but I am missing most of the details listed above
No, I am missing all of the details listed above
Other
Your Name
*
First
Last
Mr.
Ms.
Title
*
Facility Name
*
Address
Address Line 1
City
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District of Columbia
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State
Zip Code
Email
*
Phone
*
Phone Type (copy)
Office
Mobile
OTHER INFORMATION
Is there any additional information you would like to include that may be helpful?
SUBMIT
WE CAN HELP!
Interested in medical lien funding for a personal injury patient? Simply submit a new patient intake or call us with questions.
(877) 643-0010
Contact Us Today
Attorneys
New Client Intake
Attorney Portal Login
Locate a Healthcare Provider
Life Care Planning
Telehealth
Benefits to Strategic Attorneys
Attorney FAQ’s
Healthcare Providers
New Patient Intake
Provider Portal Login
Personal Injury AR Assessment
Join our Provider Network
Personal Injury 101
Lien Holding vs. Lien Funding
Locate a Healthcare Provider
Healthcare Provider FAQ’s
Patients
Get Started
How it Works
Find a Personal Injury Attorney
Locate a Healthcare Provider
Patient FAQ’s
Brokers
Refer a Portfolio of Accounts
About
Who We Are
Meet Our Team
Events
Careers
Resources
Blog
For Attorneys
For Healthcare Providers
Contact