Physician Release 2

10/12/2024

Dear Doctor,

Please allow this letter to serve as an introduction -- and request.

My name is _______. I own and operate YOUR BUSINESS. in YOUR CITY.

Your patient, {First Name::1} {Last Name::2}, wishes to retain us in order to assist in an exercise program. Enclosed, please find a medical release form. At your earliest convenience, would you be so kind as to review it, make any specific recommendations that will benefit your patient, then, sign and send back to me?

I've enclosed a self-addressed envelope for your convenience.

We offer specialized training, corrective exercise, and post rehab services for clients referred by their physicians and physical therapists.

If interested, my professional certifications and references can be found at www.digitalwelcomekit.com. Our goal is to provide safe and effective fitness programming for clients with medical conditions.

Our programs DO NOT provide or recommend treatment for any medical conditions. Instead, our motto is: "Exercise is the key to long-term management of most medical conditions."

If your time permits, I'd like to set-up a quick moment to meet with you and explain our programs and methods in-person.

Meanwhile, if you have patients who you feel could benefit from our services, please feel free to contact me directly at 714-404-1800 (mobile).

Thank you for your time and consideration.

Sincerely,

YOUR NAME, Your Certifications
YOUR BUSINESS NAME.
Date:
MM slash DD slash YYYY
First Name:*
Last Name:*
Address:*
City:*
State/Province/Region:*
Zip/Postal Code:*
Email:*
Phone:
I hereby authorize my physician to complete and forward this form to [YOUR COMPANY] and supply the information requested herein.*
Please sign with mouse, stylus or finger
-- Please Enter Your Physician's Name and Address --
Dr. First Name:*
Dr. Last Name:*
Address:*
City:*
State/Province/Region:*
Zip/Postal Code:*