Request Letter to Doctor for Clearance Letter from Doctor – Sample Letter Requesting Clearance Letter from Doctor

__________ (Receiver Details),
__________ (Name of the Clinic),
__________ (Address of Clinic)

Date: __/__/____ (Date)

Subject: Request for issuance of clearance letter

Dear Doctor,

I am _________ (name) and I am a resident of __________ (mention residence).

Respected, I have _______ (got admitted/ got my tests) done from your reputed clinic bearing reference number ___________ (mention patient ID number/ reference number/ test ID) and have received the reports. I write this letter to request the issuance of a clearance letter from your end. I have to submit this clearance letter to _________ (mention) by __/__/____ (date) for __________ (mention purpose).

It is to request you kindly consider this letter as a genuine request and issue the said document at the earliest. I shall be highly obliged for your kind support.

___________(Your Name)
___________(Contact number)

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