Dear Patient: 2025

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The document is a letter from Vail Valley Surgery Center providing information about their Financial Assistance Program for patients. It outlines the application process, required documentation, and eligibility criteria, including residency requirements in Eagle County. The letter emphasizes the need for timely submission of the application and supporting documents to receive assistance in reducing surgery center bills.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your personal information in the 'Patient Information' section, including your name, spouse or guardian details, account number, daytime phone number, date of service, and the number of household members.
Next, move to the 'Monthly Household Income Information' section. Enter your monthly income sources such as gross payroll, social security, workers compensation, unemployment benefits, child support, and any other income. Ensure you calculate the grand total accurately.
Proceed to the 'Monthly Household Expense Information' section. Fill in your expenses for mortgage/rent, utilities, food, prescription drugs, insurance, medical care, and any other relevant expenses. Calculate your total gross monthly expenses.
In the 'Authorization' section, read through the statements carefully. Sign and date where indicated to certify that all information provided is true and complete.

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Address the patient by name. Suppose youve just got an email from your doctor that starts with something generic like Dear patient. It doesnt exactly make you feel special or valued, does it? Instead, take the time to find out and use the patients name.

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When you get a new patient, they should be addressed by their title Mr., Miss, Mrs., Dr., etc. and their last name. This is the most respectful way to begin a nurse-patient relationship. If the patient wants you to call them something different and they correct you, do your best to remember their wishes.