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Healthcare Providers
Patients
Brokers
- Refer a Portfolio of Accounts
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Contact

Personal Injury AR Assessment

Please tell us more about your Personal Injury Accounts Receivable.

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

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?

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

National Health Finance DM, LLC
1347 North Alma School Road, Suite 120
Chandler, AZ 85224

Se habla español.

Toll Free: (877) 643-0010
Office: (602) 347-8503
Fax: (602) 347-8501

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National Health Finance & Affiliate Companies (NHF) does not direct care nor make medical or legal decisions. NHF is not a medical provider nor health insurance carrier. The information contained on this website is for informational purposes and is not to be considered legal advice, an agreement of funding or inclusive of all terms and conditions.

National Health Finance is wholly-owned by publicly traded Australia company LawFinance Limited (ASX: LAW).

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National Health Finance DM, LLC

Attorneys
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