Medical Debt Intake Form


We use a four part analysis of litigation options (counter-claims, affirmative defenses, and procedural defenses), settlement options, bankruptcy options (if the debt is large enough), and other out of court options (very broad category) to find the best method to resolve the debt.  You choose which methods you like and we get to work.


  • Cases of any amount where you are considering bankruptcy as an option
  • All cases above $5,000.00 in controversy for the medical debt collection
  • Cases below $5,000.00 in controversy IF there is a valid consumer protection counter claim or defense (see below)


  • Balance billing (RCW 48.49 et. seq.)
  • Charity care (to include requesting it and when creditors don’t honor discount)
  • Double billing by medical provider
  • FDCPA, FCRA, RCW 19.16 counter claims
  • Fraud or error in calculating proper interest by the medical provider or collection agency
  • Identity theft
  • Improper party (such as an ex spouse’s post divorce debt)
  • Improper service of process (see our Improper Service Defense Page)
  • Statute of limitations (generally 6 years in WA, see RCW 4.16.040)
  • The insurer improperly denied coverage
  • The medical provider did not properly or timely bill insurance (wrong code, waited too long)


  • Charity Care– If your medical services were rendered at a public hospital, you may be eligible for charity care.  This can reduce or waive your medical bills.  You have an ongoing right to apply, even if you are in collections or have been garnished.  Click the link if you wish to learn more.
  • Notice of Appearance– If you have been sued you have 20 days to answer.  Be sure to submit a notice of appearance timely, even if you have already been scheduled and are just waiting to talk to us.  Instructions and form in the link.


Cut and paste the form below into an email, pdf, or word document and send to us.  For a response within 24-72 hours, email to  If you need a faster response, call in directly at 206-535-2559 to speak with one of our staff.



INSTRUCTIONS: Cut and paste this form into an email, pdf, or word document and send to us.  For a response within 24-72 hours, email to  If you need a faster response, call in directly at 206-535-2559 to speak with one of our staff.  If you have been served a summons and complaint and are within the 20 required days to answer, please go to our free notice of appearance form and file with the court and creditor prior to the deadline.

Free consultation policies & Notice of Appearance:

Documents that we review for free (please send): Summons and complaint, demand letter/s regarding the claim

Documents that we must charge to review (ask before sending): Motion for Summary Judgment (MSJ), Explanation of Benefits (EOB), detailed billing statements.  We bill in 30 minute increments ($150.00) to review, most docs can be reviewed in 30 minutes.


1. Contact Information: Name, email, phone.  If you have a legal name that is different than the name you use, please specify which is your legal name and which is your preferred name.  Because courts use legal names, it is important that we understand the distinction.


2. Any specific requests or accommodations (no calls during work hours/email only, preferred pronouns, hearing disabled, etc.)


3. Amount of the debt for the collection claim that you are contacting us for?


4. Is there a defense or counterclaim to the debt referenced in question 3 that you are aware of?  List all that you believe might apply.  If improper service or identity theft apply, please complete those additional intake forms.


5. Are there any other debts (to include medical and non-medical) in collection?  Is so, please list a rough aggregate amount (10k total for example)


6. Name of the medical provider (hospital, private clinic, dental office, etc., name of specific dr. not necessary)


7. Were you insured at the time of the medical service and if so, was it billed to your insurance?

If no, please state so.  If yes, please obtain all relevant Explanation of Benefits (EOB) prior to your consult- to do this call your insurer.  Do not email or mail these in, have them handy to discuss and have read them prior to consult.  We need to know if the insurer did not receive the bills, if they declined to pay them and why, or that they did pay.


8. Have you applied for charity care?  This applies only to public medical providers like hospitals.  If so was it approved?


9.  Collections company information (if applicable): Please list out the name of the collections company or companies that have been in contact with you, starting with the most recent and working backwards.


10. Collection law firm and/or attorney (if applicable): If you have been contacted by a law firm, have all communications, demand letters, and legal pleadings handy.  If you are wishing to defend on the merits, we will likely need a copy of everything sent electronically.


11.  Please indicate which of the following four solutions that you would like to discuss and any that you would like to keep off the table: Litigation options, Settlement, Bankruptcy, Other out of court options (usually charity care).


12. Any narratives or chronologies or other information that you would like use to know about or consider in analyzing your case.  This could be a rough timeline of your insurance coverages, that you are trying to buy a house and it is impacting your purchase, you are about to get married and concerned that your partner will be impacted, this will impact your security clearance or FINRA license, etc.