Patient Balance Template

DOCUMENT OVERVIEW: It is important that your office politely and effectively communicate
with patients regarding balances. This document may be used early in the patient billing cycle
as a reminder of outstanding fees for services rendered. Courteous and timely patient billing
procedures often result in timely payment and a reduced accounts receivable.



Dear [name]:

A review of our unpaid accounts indicates that you have an overdue balance of [$—].

You may use the enclosed preaddressed stamped envelope to send us a check or to provide
credit card information to pay off the outstanding balance. Alternatively, please contact us at
[telephone number] and provide us your credit card information over the telephone in order to
transfer your balance.

If you have any questions, please call. We value you as a patient.