This Printable Business Form Template belongs to these categories: medical
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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.
Sincerely,
Danny Daniels
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