Medical Request
Letters

Sample Medical Request Letters

This type of letter can request anything from a second opinion to a payment adjustment. As the name suggests, it requests information or a particular course of action from either a doctor or medical facility.

Examples include the letters that request a second opinion, dental/medical records or a patient requesting a dental clinic to adjust the payment due them.

The medical request letter can be just a few short paragraphs long or take up more than a page, depending on the information you feel it must include and the reason for writing.

If you are requesting your dental records be forwarded to another dentist, the letter can make do with a few short paragraphs. However, if your are asking a dental clinic to adjust the payment you owe them, the letter may need to be longer to make sure all points are covered and it does a good "selling" job.

The request letter must request, not demand. Besides, it always pays to keep your emotions in check and not to come across as being demanding . . . even in a letter. Include all information you think will help the doctor or medical facility take the necessary step to grant your request as soon as possible. Assume nothing.

[Ms./Mr. Name]
[Title]
[Organization]

Dear [Ms./Mr. Last name],

I have been a resident of [Town/City] for over [#] years and during all that time I have sought medical care only at the [Medical facility].

Due to a job transfer, I am now relocating to [Town/City] and would like the [Medical facility] to transfer my medical records to the following hospital, care of the Supervisor, Administration and Records:

[Hospital]
[Address]
[Contact details]

My case file number is [#].

My last visit to the [Medical facility] as a patient was in May 2010.

I would also like to take this opportunity to convey my sincere thanks and appreciate the many years of exceptional care that I have experienced at the [Medical facility].

I have not only been an outpatient at the [Medical facility] many times, I have also had four surgeries under its roof. I must say that on almost each occasion, the doctors and support staff went above and beyond the call of duty to make the experience as dignified as it could be.

I especially thank [Dr./Ms/Mr. Name], [Dr./Ms/Mr. Name], [Dr./Ms/Mr. Name], [Dr./Ms/Mr. Name] and last but not the least, [Dr./Ms/Mr. Name].

I have no hesitation in highly recommending both the [Medical facility] and the doctors who staff it to anyone who cares to listen!

[Signature]
[Name]
[Identification #]

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[Ms./Mr. Name] 
[Title] 
[Organization]
 Dear [Ms./Mr. Last name],
 I have been a resident of [Town/City] for over [#] years and during all that time I have sought medical care only at the [Medical facility].
 Due to a job transfer, I am now relocating to [Town/City] and would like the [Medical facility] to transfer my medical records to the following hospital, care of the Supervisor, Administration and Records:
 [Hospital] 
 [Address] 
 [Contact details]
 My case file number is [#].
 My last visit to the [Medical facility] as a patient was in May 2010.
 I would also like to take this opportunity to convey my sincere thanks and appreciate the many years of exceptional care that I have experienced at the [Medical facility].
 I have not only been an outpatient at the [Medical facility] many times, I have also had four surgeries under its roof. I must say that on almost each occasion, the doctors and support staff went above and beyond the call of duty to make the experience as dignified as it could be.
 I especially thank [Dr./Ms/Mr. Name], [Dr./Ms/Mr. Name], [Dr./Ms/Mr. Name], [Dr./Ms/Mr. Name] and last but not the least, [Dr./Ms/Mr. Name].
 I have no hesitation in highly recommending both the [Medical facility] and the doctors who staff it to anyone who cares to listen!
 [Signature] 
 [Name] 
 [Identification #]

Print this Letter