Which form is completed and signed by new patients presents a statement about patient payment responsibility?

• A. Consent form
• B. Patient information form
• C. Treatment plan form
• D. Registration form

Answer: (B)

Capturing who is responsible for payment happens at new-patient intake on the patient information form, which the patient signs to acknowledge financial responsibility. This form collects essential details like demographics and insurance, and it often includes a statement that the patient understands they are responsible for charges not covered by insurance, including copays, deductibles, and any non-covered services. Having this signed acknowledgment creates a clear agreement about payment expectations and supports the billing process by showing the patient’s commitment to pay for services rendered. The other forms serve different purposes: a consent form is for agreeing to treatment, a treatment plan form outlines recommended care, and a registration form handles administrative check-in; none specifically function as the standard vehicle for a patient’s payment responsibility acknowledgment.