Collection Report Template

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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