Printable Business Form Templates
Medical Records Release Letter Business Form Template

123 Main St., Apt. #5
Anytown, CA 95928
(555) 555-1212
[email protected]

November 8, 2008

Anytown Medical Center
345 Goodhealth Place
Anytown, CA 95928

Dear Dr. Goodcare:

I am writing to authorize you to release my medical records to the office of Dr. Nice. He has expressed a desire to see my files to gain a more complete picture of my ongoing digestive problems.

Please send the files at your earliest convenience to: 134 Nice Way, Anytown, CA 95928.


Danny Daniels

Copyright © 2008-2024 by Savetz Publishing, Inc. Contact us. Privacy Policy.