Sample Physician Letter of Prescription

This letter MUST be written on your physician’s letterhead and include his/her signature and license number.

Download PDF Version of Service Animal Prescription Letter

Date:_____________

To Whom It May Concern:

________________________ is a patient under my care. They are disabled, as their condition limits one or more major life activities. I have prescribed an assistance animal to aid them in living with their disability. This animal provides them with needed support and assistance that improves their quality of life.

If you have further questions, please feel free to call me at my office number.

Sincerely,

___________________________________
Medical Provider

___________________________________
License Number

For more information contact Steve Wayland 2 213.741.1950 x 114