Engagement Letter and Power of Attorney Forms

Engagement Letter

This letter defines the scope of Broken Healthcare’s involvement with your billing issues. Please note, by signing the letter, you are not financially obligate in any way. There is no charge involved in working with BrokenHealthcare.org.

Download Engagement Letter

Power of Attorney

By completing the Power of Attorney letter, you are giving permission to Broken Healthcare to the hospital or collections agency on your behalf.

Download Power of Attorney

Please read and complete both of the forms above and return to admin@brokenhealthcare.org.