Release Forms

If you have a dissatisfied patient who demands a refund, whether the issue is a set of dentures that the patient just does not like even after a Herculean effort on your part, or a root canal procedure that did not succeed due to a separated instrument or un-instrumented canal, you should never provide such a refund unless you have the patient sign a Release of All Claims form first.

There are several circumstances that must be addressed through these forms.  For example, if you are terminating the dentist/patient relationship, that can be clarified in the Release form.  You might be providing the payment directly to another dentist, and PIE has sample forms for that circumstance.  You may be writing off an account in addition to providing a refund.  You may demand the dentures back from the patient before you issue the refund.  Again, we have Release forms ready to handle nearly every combination of circumstances that you can imagine.

 These Release forms hold up in court as we can attest from prior experience over the past twenty years.  Even if a patient decides later to contest the Release or tries to sue even though the Release form has been signed and money returned, they will run into a stiff hurdle once we provide a copy of the Release to their lawyer.  In many instances, once the lawyer sees the Release, that is the end of the patient’s attempt to sue even though they signed the Release previously and waived their right to make any further claim, as the lawyer will advise them that it is nearly impossible to overcome one of these Release forms once they have been signed.

These Release forms are a benefit intended for PIE insured and we also like to coach the dentist involved to determine which Release form should be used and to help the dentist deal with any objections the patient may come up with.  Therefore, we are not providing samples here but encourage our insured to call us immediately should they determine that a refund may be indicated.  Non-insured or potential insured should be able to see the immediate value of these Release forms which PIE provides to help its member dentists.

If you have a situation with a patient where you may need one of our Release forms, please call us at 801-262-0200 or e-mail us at pie@pieutah.org.