Collection Report Template

Updated: Apr 22

Daily COLLECTIONS FORM-Sample

Client Name	Amt. Due	Amt. Paid	Method of Payment: Cash/Check/Card	Comments
















		Totals:	Cash/Check/Card Totals:

When collecting payments from clients.
Provide a carbon/carbonless receipt.
Enter all payments onto this ledger.
Indicate both Amount Due & Amount Paid.
Enter Method of payment:
- Indicate Cash
- If Check include the check # (stamp all Checks promptly with a “FOR DEPOSIT ONLY to CLINIC ACCOUNT)
- If Charge indicate Card Type (Visa/MC/etc.)
Total all payments & verify against receipts
Report Cash/Check/Credit Card Totals & cross check for accuracy with receipts.
Record any comments about payment including lack of payment, pre-payment, concerns, etc
Attach client receipts for all payments.
Turn in daily to Billing Office/Owner for deposit.

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Collection Report Template (English)

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