Sample Physician Letter of Prescription

Please use this letter as a template only. Your letter MUST be on your physician’s letterhead and include his/her signature and license number.

Click here to download a PDF version of this Physician Letter of Prescription

Date:_____________

To Whom It May Concern:

________________________ is a patient under my care. She (He) is disabled, as her (his) condition limits one or more of her (his) major life activities. I have prescribed service animals for emotional support. These animals will help her (him) to cope with her disability. These animals will lower her (his) stress level and alleviate some of her (his) isolation. It has been shown that people with potentially fatal diseases live longer when a service animal is present. If you have further questions, please feel free to call me at my office number.

Sincerely,

___________________________________
Medical Provider

___________________________________
License Number