Printable Business Form Templates
Medical Release Letter Business Form Template


123 Marygold St.
Anytown, CA 95928
(555) 555-1212

November 1, 2008

Attention [name of doctor, hospital or treatment center]:

I, Jennifer Jensen, authorize my daughter, Holli Hollister, of 123 Marigold St., to authorize any necessary emergency medical care on my behalf in the event that I am not able to do so.

This authorization is valid from November 1 through December 31 of 2008.

Sincerely,

Jennifer Jensen








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