Get the free Guarantor (if patient is minor)

General Information Please complete this form entirely. Patient Name (Last, First, MI) Date of Birth Street Address City, State, Zip Home Phone Cell Phone Work Phone Occupation Email Address Emergency

How to fill out guarantor if patient is

How to fill out guarantor if patient is

1. To fill out a guarantor if the patient is:
2. Gather all the necessary information about the guarantor, including their full name, address, phone number, and relationship to the patient.
3. Provide the guarantor's social security number or taxpayer identification number.
4. Fill out the guarantor's employment information, such as their employer's name, address, and contact number.
5. Indicate whether the guarantor has any other insurance coverage.
6. Sign and date the guarantor section of the form to validate the information provided.

Who needs guarantor if patient is?

1. A guarantor is needed if the patient is:
2. - A minor who cannot legally enter into a contract.
3. - Uninsured or underinsured and requires financial responsibility for medical bills.
4. - Incapable of making their own medical decisions and requires someone to act on their behalf.
5. - Receiving healthcare services from a medical facility that requires a guarantor for billing purposes.

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