Medical Authorization Letter Sample

Learn how to write Authorization Letter. You can use this sample Authorization Letter format directly as well.

A medical authorization letter should be clear and to the point and short. Be specific on whom you are authorizing and what you expect the reader to do. Below given letter is an authorization letter for the release of medical documents. Ensure that your tone is professional and straightforward throughout the letter

Your name
Your Address
Your City state, zip
Your Phone number,
Your Email

Date

Doctors Name
address,
City, State, Zip.

                                           To whomsoever it may concern,

I _________________ (your name) hereby authorize ____________(doctors name) to provide __________(another doctors name ),all my medical reports; x rays, lab reports, and all information of the treatment I took from ___________ doctor since ____________(date).I give my permission to use these information for further diagnosis and treatment of my ____________(name of the illness). I do not allow this to be used for any other purpose.

You can contact me at __________ if you have an further questions

Your name

Signature

Date of signature