Collection Letter 2

September 11, 2014

If patient has already been send the Collection Letter 1 and no payment was received, send this letter out after the first statement is 60 days stale.

To download this form, click here: Collection Letter 2.doc




[Patient’s name]


[City, State, ZIP]


Account Balance:        $[Dollar value]

Account Number:       [Account number]

Date Last Paid:           [Date]


Dear [Name]:


Our records indicate that you have an outstanding balance with our office in the amount indicated above. Also according to our records, your balance is now over 60 days old.

In an effort to settle this account in a most reasonable way, we are asking that you remit full payment as soon as possible. If you cannot pay the full amount at this time, please contact our office immediately to discuss a payment arrangement.

Failure to contact our office or remit full payment will result in more severe collection efforts. If your payment has already been sent, please disregard this notice. Thank you for your cooperation.




[Office manager or collection clerk signature block]

To download this form, click here: Collection Letter 2

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