Let this proven sample form ease your efforts Verifying patient benefits is good practice, but it takes time away from your other billing duties. Using a standard data collection form such as this one from Charlene Travis, CPC, biller and patient account representative at Chesapeake Surgery Center in Salisbury, Md., can help make the process easier and less time consuming. Chesapeake Surgery Center uses this form to verify both primary and secondary insurance for patients, Travis explains.