Medical Letter Request

To request a medical letter, please fill out the following form, including all necessary information in detail. A 48-hour notice is required for any type of medical letter request.

Enter Letter Request Information Here
  1. (required)
  2. (valid email required)
  3. (required)
  4. Who is your doctor at For Better Health?
  5. (required)
  6. (required)
  7. (required)
  8. Should this letter be mailed or faxed?
  9. (required)
  10. (required)
  11. (required)

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