(Sender’s details)

Date: __/__/_____ (Date)

Dr. ________ (Doctor name),
________ (Clinic/Hospital Name),
________ (Clinic/Hospital Address)

Subject: Request for prescription


My name is __________ (name) and I am a resident of _________ (locality).

I am most respectfully writing this letter in order to request you for issuance of ________ (duplicate/any other) prescription. My patient ID is _______ (patient ID). This is to apologetically inform you that I have got diagnosed with ______ (mention) and the treatment is going on since ______ (mention duration). I am writing this letter to request you for issuing ________ (duplicate/any other) prescription for appointment done on __/__/____ (date) for _________ (mention purpose).

I shall be highly obliged for your kind support. You may contact me at _________ (contact number).

Yours sincerely
________ (Signature),
________ (Name),
________ (Contact Number)

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