Recommendations can be very concise. We provide a template here – one being used currently in physicians’ practices.

If the physician’s letterhead and contact information is added, this form will suffice.

It is advised to provide two copies to the patient, one for their files and one to carry with them. At least one of these copies should be embossed to verify it is the original. A third copy should be kept in the patient’s chart.

If the patient chart has a full medical history and examination, and a release of liability statement signed, a simple statement of recommendation is all that is needed.

This form is provided as an example only.

Sample approval form: Recommendation Template