Assignment of Benefits (Sample)
Please find the attached Assignment of Benefits. Before use, please ensure that your exact legal name is typed in the same provided. This is part is very important- make sure you have an Assignment for each of the companies you treat under. For example, if you treat under Jon Smith Chiropractic Inc. (for adjustments) and Jon Smith Rehabilitation (for massage therapy) then you will need two Assignments, one for each company. Feel free to call my office if you aren’t