In different states it is referred to differently, but it is essentially a lien letter. Your attorney should be handling that, however. If you don't have an attorney, do NOT sign anything until you get one!
Because of a change in Texas law in 2003 designed to make sure you get less in a personal injury case, this is now a very complicated question. If you were hurt enough to need physical therapy (I assume that is what you mean by pt), then you need to get a lawyer. There will be a negotiation with your provider now and after the case is resolved, and you need a lawyer's help to understand what is going on.
This is not legal advice. You should always discuss the specifics of your issue in person with an attorney. Be aware that there are time limits on all claims that depend on the kind of claim, so do not delay in seeking an attorney.
The document is generally referred to as a "letter of protection", which serves to assure the health care provider of payment for their services when the case settles. There are samples available on some websites.
I agree with the advice of my colleagues - consult a local attorney before signing any documents. Many offer free consultations.
This is not intended to be legal advise or as legal representation. I am a California personal injury attorney . Be aware that every state has its own statute of limitations; and statutes & case laws that govern the handling of these matters.
Your lawyer can issue a letter of protection. Not sure what 'form' you are referring to.
All information provided here is for educational use only and does not constitute legal advice nor establish any attorney-client relationship. Paul H. Cannon is licensed to practice law in the State of Texas. Laws vary from State-to-State. For legal advice and opinions, please retain the services of a lawyer licensed to practice in the appropriate state or jurisdiction.
In Texas it is known as a " letter of protection" which is usually issued by the personal injury lawyer.
This answer is intended to be general in nature and not specific as to any person or fact situation. No attorney-client relationship exists for those reading this answer and readers should contact an attorney of their choosing for legal advice on their specific situation.